Provider Demographics
NPI:1124373709
Name:PRICE, RAY ANTHONY (LDN, RD)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:ANTHONY
Last Name:PRICE
Suffix:
Gender:M
Credentials:LDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 TIGER DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4337
Mailing Address - Country:US
Mailing Address - Phone:985-447-0916
Mailing Address - Fax:985-447-0920
Practice Address - Street 1:1434 TIGER DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4337
Practice Address - Country:US
Practice Address - Phone:985-447-0916
Practice Address - Fax:985-447-0920
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1357133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered