Healthcare Provider Details

I. General information

NPI: 1295704187
Provider Name (Legal Business Name): TIMOTHY C. BRAY, D.O. HOSPITAL CONSULTANTS A PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 LAKEVIEW PKWY STE 200
ROWLETT TX
75088-4355
US

IV. Provider business mailing address

7600 LAKEVIEW PKWY STE 200
ROWLETT TX
75088-4355
US

V. Phone/Fax

Practice location:
  • Phone: 214-663-7733
  • Fax:
Mailing address:
  • Phone: 214-663-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH9496
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberH9496
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH9496
License Number StateTX

VIII. Authorized Official

Name: THOMAS MILLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-663-7733