Provider Demographics
NPI:1164586806
Name:RAY, KARL ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:ARTHUR
Last Name:RAY
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:PO BOX 6336
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-6336
Mailing Address - Country:US
Mailing Address - Phone:505-820-5985
Mailing Address - Fax:505-989-3298
Practice Address - Street 1:455 SAINT MICHAELS DR
Practice Address - Street 2:ST. VINCENT REGIONAL MEDICAL CENTER
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7601
Practice Address - Country:US
Practice Address - Phone:505-820-5985
Practice Address - Fax:505-989-6489
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM83-2782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM25361Medicaid
NMC98050Medicare UPIN
NM2135063Medicare ID - Type Unspecified