Healthcare Provider Details

I. General information

NPI: 1205814803
Provider Name (Legal Business Name): JON B OBRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 02/23/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2891 E MALL DRIVE, STE 101
ST GEORGE UT
84790
US

IV. Provider business mailing address

PO BOX 912042
ST GEORGE UT
84791-2042
US

V. Phone/Fax

Practice location:
  • Phone: 435-656-2424
  • Fax: 435-656-2828
Mailing address:
  • Phone: 435-215-0230
  • Fax: 435-986-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number7364782-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: