Healthcare Provider Details

I. General information

NPI: 1851910475
Provider Name (Legal Business Name): ERIC BRAY MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NW 10TH AVE # 2023A
MIAMI FL
33136-1015
US

IV. Provider business mailing address

3172 MCDONALD ST
MIAMI FL
33133-4417
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4472
  • Fax: 305-243-6191
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: