Provider Demographics
NPI:1972354595
Name:BRAY, BROOKS
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:
Last Name:BRAY
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:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:SPALDING
Mailing Address - State:MI
Mailing Address - Zip Code:49886-0118
Mailing Address - Country:US
Mailing Address - Phone:415-259-1586
Mailing Address - Fax:
Practice Address - Street 1:W3752 PINE AVE
Practice Address - Street 2:
Practice Address - City:SPALDING
Practice Address - State:MI
Practice Address - Zip Code:49886-9761
Practice Address - Country:US
Practice Address - Phone:415-259-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No372500000XNursing Service Related ProvidersChore Provider