Provider Demographics
NPI:1104353622
Name:BRAY, KORBIN ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:KORBIN
Middle Name:ANDREW
Last Name:BRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 E RENNER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2227
Mailing Address - Country:US
Mailing Address - Phone:972-234-3311
Mailing Address - Fax:
Practice Address - Street 1:1410 E RENNER RD STE 201
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2227
Practice Address - Country:US
Practice Address - Phone:972-234-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU0970207Q00000X
IL125.070896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine