Provider Demographics
NPI:1093804809
Name:ANDREW, RAY ALLEN (MD)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:ALLEN
Last Name:ANDREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 WILLIAMS WAY
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2370
Mailing Address - Country:US
Mailing Address - Phone:435-259-4466
Mailing Address - Fax:
Practice Address - Street 1:255 WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2370
Practice Address - Country:US
Practice Address - Phone:435-259-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5141202-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT68474OtherPEHP
UT680511576ANDOtherEDUCATORS MUTUAL
UT51412021201001OtherBLUE CROSS BLUE SHIELD
UTQM0000071700OtherALTIUS
UT755227OtherDMBA INSURANCE
UT107012421102OtherSELECT HEALTH
UTQM0000071700OtherALTIUS
UTH53849Medicare UPIN