Healthcare Provider Details

I. General information

NPI: 1003985284
Provider Name (Legal Business Name): KANSAS L DU BRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S2845 WHITE EAGLE LANE
BARABOO WI
53913
US

IV. Provider business mailing address

S2845 WHITE EAGLE LANE
BARABOO WI
53913
US

V. Phone/Fax

Practice location:
  • Phone: 608-355-1240
  • Fax: 608-356-6347
Mailing address:
  • Phone: 608-355-1240
  • Fax: 608-355-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42772020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42772020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: