MEDICARE: ANGELA B BRAY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9102817	FL
2	363AM0700X	Medical Physician Assistant	PA-377	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59177261	OTHER	AL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558346213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA B BRAY PA-C

Provider Business Mailing Address
First Line	:	1055 CANDLEWOOD CIRCLE
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-0000
Country	:	US
Telephone Number	:	850-549-1387
Fax Number	:

Provider Business Practice Location Address
First Line	:	8596 ORANGE AVENUE
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534
Country	:	US
Telephone Number	:	850-549-1387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	06/12/2013

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Directions to “ ANGELA B BRAY PA-C” Practice Location

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