Wray Dermatology

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

WRAY DERMATOLOGY

Practice address

1355 Parkway Dr Ste a
Blackfoot, ID 83221-1656

Phone

(986) 275-0003

Fax

(986) 275-0005

NPI assigned

Mar 14, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Adam Wray, DONPI 1902952930

Title

Owner

Phone

(986) 275-0003

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Adam Wray, DO

  • Dermatology Physician
  • Blackfoot, ID
  • NPI 1902952930
  Medicare reassignment Care Compare group NPD Authorized official
• Tanner D Mitton, PA-C

  • Physician Assistant
  • Blackfoot, ID
  • NPI 1144601865

  Dermatology

  Medicare reassignment Care Compare group NPD (past)
• David Woodbury, PA

  • Physician Assistant
  • Blackfoot, ID
  • NPI 1598136368
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778025600000",
    "number": "1457110298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 PARKWAY DR STE A",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211656",
            "telephone_number": "986-275-0003",
            "fax_number": "986-275-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 PARKWAY DR STE A",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211656",
            "telephone_number": "986-275-0003",
            "fax_number": "986-275-0005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 S 11th Ave Ste 301",
            "address_purpose": "LOCATION",
            "city": "Pocatello",
            "state": "ID",
            "postal_code": "832014879",
            "country_code": "US",
            "telephone_number": "986-228-8765",
            "fax_number": "986-275-0005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WRAY DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-14",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A",
        "authorized_official_last_name": "WRAY",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "986-275-0003",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Joyce Wolfley, M.S., CCC-SLP
• Sharee Julett Wolfley
• David Woodbury, PA
• Meghan L Woolstenhulme
• Jared Worthington, DDS
• Adam Wray, DO
• Amanda Wray, RPH
• Lee Brock Wren, OD
• Shawn A Wren, CRNA
• Barbara Pancoast Young, LCSW

• Dermatology Physician in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• Dermatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.