Healthcare Provider Details

I. General information

NPI: 1851559884
Provider Name (Legal Business Name): MONICA M MADRAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SAN GABRIEL VILLAGE BLVD STE 105
GEORGETOWN TX
78626-5594
US

IV. Provider business mailing address

700 SAN GABRIEL VILLAGE BLVD STE 105
GEORGETOWN TX
78626-5594
US

V. Phone/Fax

Practice location:
  • Phone: 512-819-9910
  • Fax: 512-819-9970
Mailing address:
  • Phone: 512-819-9910
  • Fax: 512-819-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberN4566
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberN4566
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: