Healthcare Provider Details

I. General information

NPI: 1033300512
Provider Name (Legal Business Name): JOHN L BRAY M.S., MT(ASCP)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

14469 CHRISTEN DR
JACKSONVILLE FL
32218-0854
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax:
Mailing address:
  • Phone: 904-683-3290
  • Fax: 904-683-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License NumberTN36736
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number01413575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: