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General NPI Number Information
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NPI Number | 1669676276
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Entity Type | Organization
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Legal Business Name | S. JEFF BRAY, DPM, INC.
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 2240 E CENTER ST
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City | POCATELLO
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State | ID
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Zip | 83201-2600
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Country | US
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Telephone | 208-233-2100
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Fax | 208-233-3146
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Provider Business Mailing Address
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Address Line | 2240 E CENTER ST
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City | POCATELLO
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State | ID
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Zip | 83201-2600
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Country | US
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Telephone | 208-233-2100
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Fax | 208-233-3146
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. S JEFF BRAY
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Credential | DPM
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Telephone | 208-233-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | P157
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License Number State | ID
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