Provider Demographics
NPI:1225191539
Name:OBRAY, CATHLEEN MAGILL (MD)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:MAGILL
Last Name:OBRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:M
Other - Last Name:MAGILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:435-251-2600
Mailing Address - Fax:435-251-2610
Practice Address - Street 1:1380 E MEDICAL CENTER DR
Practice Address - Street 2:SUITE 2200
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2123
Practice Address - Country:US
Practice Address - Phone:435-251-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD66063207R00000X
MN51185207R00000X
UT7624273-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MD013884300Medicaid
MN110012253Medicare PIN
MD013884300Medicaid