Provider Demographics
NPI:1275732927
Name:BRAYBOY, JACOB RYAN
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:RYAN
Last Name:BRAYBOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 OBERLIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605
Mailing Address - Country:US
Mailing Address - Phone:919-322-4722
Mailing Address - Fax:919-322-4729
Practice Address - Street 1:815 OBERLIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605
Practice Address - Country:US
Practice Address - Phone:919-322-4722
Practice Address - Fax:919-322-4729
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine