Provider Demographics
NPI:1073261301
Name:ST JOHN, RAY
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:ST JOHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 SAWTOOTH DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6766
Mailing Address - Country:US
Mailing Address - Phone:757-773-4133
Mailing Address - Fax:
Practice Address - Street 1:1024 SAWTOOTH DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6766
Practice Address - Country:US
Practice Address - Phone:757-773-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No172A00000XOther Service ProvidersDriver