Provider Demographics
NPI:1487648945
Name:WRAY, ROBERT E (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:WRAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:711 MARSH AVE
Mailing Address - Street 2:
Mailing Address - City:KINSLEY
Mailing Address - State:KS
Mailing Address - Zip Code:67547-1129
Mailing Address - Country:US
Mailing Address - Phone:620-659-2890
Mailing Address - Fax:620-659-2897
Practice Address - Street 1:810 W BRAMLEY ST
Practice Address - Street 2:
Practice Address - City:JETMORE
Practice Address - State:KS
Practice Address - Zip Code:67854-9320
Practice Address - Country:US
Practice Address - Phone:620-357-8354
Practice Address - Fax:620-357-6460
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-22793207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100230630EMedicaid
KS100230630EMedicaid