Provider Demographics
NPI:1003378308
Name:RAY, JONATHAN (DPM)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 W THUNDERBIRD RD
Mailing Address - Street 2:G700
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4691
Mailing Address - Country:US
Mailing Address - Phone:602-938-3600
Mailing Address - Fax:602-938-0400
Practice Address - Street 1:5750 W THUNDERBIRD RD G700
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4660
Practice Address - Country:US
Practice Address - Phone:602-938-3600
Practice Address - Fax:602-938-0400
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZPOD-001045213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program