Provider Demographics
NPI:1083748800
Name:DAVID A RAY DO PA
Entity Type:Organization
Organization Name:DAVID A RAY DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO PA
Authorized Official - Phone:940-683-2297
Mailing Address - Street 1:808 WOODROW WILSON RAY CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-2061
Mailing Address - Country:US
Mailing Address - Phone:940-683-2297
Mailing Address - Fax:940-683-2984
Practice Address - Street 1:808 WOODROW WILSON RAY CIR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2061
Practice Address - Country:US
Practice Address - Phone:940-683-2297
Practice Address - Fax:940-683-2984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDOE2807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079676501Medicaid
TX079676501Medicaid
TXA67551Medicare UPIN