Provider Demographics
NPI:1316087372
Name:OBRAY, RICK WHITE (MD)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:WHITE
Last Name:OBRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:435-215-0230
Mailing Address - Fax:435-986-7092
Practice Address - Street 1:2891 E MALL DRIVE
Practice Address - Street 2:STE. 101
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7077
Practice Address - Country:US
Practice Address - Phone:435-656-2424
Practice Address - Fax:435-656-2828
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT745184912052085R0202X, 208VP0014X
MDD636122085R0202X
UT7451849-1205208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN090000037Medicare PIN