1164410056 NPI number — JOHN D BRAY-MORRIS MD

Table of content: JOHN D BRAY-MORRIS MD (NPI 1164410056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164410056 NPI number — JOHN D BRAY-MORRIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAY-MORRIS
Provider First Name:
JOHN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164410056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 SAINT MICHAELS DR
Provider Second Line Business Mailing Address:
MEDICAL STAFF OFFICE
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-7601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-820-5227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 SAINT MICHAELS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-7601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-982-6241
Provider Business Practice Location Address Fax Number:
505-982-6280
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20030404 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NM001R78 . This is a "BCBS NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 202021218 . This is a "PRESBYTERIAN HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75976021 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: QMP000003397703 . This is a "MOLINA" identifier . This identifiers is of the category "OTHER".




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