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General NPI Number Information
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NPI Number | 1053947515
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Entity Type | Individual
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Provider Name | PHILLIP BRAY DO
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Gender | Male
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 1959 NE PACIFIC ST
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City | SEATTLE
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State | WA
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Zip | 98195-5001
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Country | US
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Telephone | 206-543-3750
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Fax | 206-543-9520
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Provider Business Mailing Address
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Address Line | 1 JARRETT WHITE RD
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City | TRIPLER ARMY MEDICAL CENTER
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State | HI
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Zip | 96859-5001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 77673-21
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 77673-21
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | OP61512333
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License Number State | WA
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