MEDICARE: DR. THOMAS JAMES WRAY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D97841	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	127310100	OTHER	TX	FIRST CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	84Z209	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1003812108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JAMES WRAY D.O.

Provider Business Mailing Address
First Line	:	23 HOSPITAL DR
Second Line	:	STE 102
City	:	ABILENE
State	:	TX
Zip	:	79606-5270
Country	:	US
Telephone Number	:	325-695-6370
Fax Number	:	325-692-6595

Provider Business Practice Location Address
First Line	:	23 HOSPITAL DR
Second Line	:	STE 102
City	:	ABILENE
State	:	TX
Zip	:	79606-5270
Country	:	US
Telephone Number	:	325-695-6370
Fax Number	:	325-692-6595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	12/20/2007

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