Basic Information
| Provider Information | |||||||||
| NPI: | 1871577171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAY | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | JAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 29TH AVE N STE 202 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153274304 | ||||||||
| FaxNumber: | 6153277940 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 29TH AVE N STE 202 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153274304 | ||||||||
| FaxNumber: | 6153277940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD.26124 | AL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 57081 | TN | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 7148637 | 01 | AETNA | OTHER | R00156942 | 01 | TRAVELERS MEDICARE | OTHER | 23898 | 05 | AL | MEDICAID | 631003288 | 01 | CHAMPUS CLAIMS CENTER | OTHER | CB0222 | 01 | TRAVELERS MEDICARE | OTHER | 631003288 | 01 | CHAMPUS VA | OTHER | 748637 | 01 | AETNA US HEALTHCARE | OTHER | 631003288 | 01 | TRICARE | OTHER | 051523898 | 01 | BCBS | OTHER | 7148637 | 01 | AETNA INS | OTHER |