Provider Demographics
NPI:1164903894
Name:DOLBERRY, RAY (BOCPO)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:DOLBERRY
Suffix:
Gender:M
Credentials:BOCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 E DEVON DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3817
Mailing Address - Country:US
Mailing Address - Phone:480-364-9905
Mailing Address - Fax:
Practice Address - Street 1:544 E DEVON DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3817
Practice Address - Country:US
Practice Address - Phone:480-364-9905
Practice Address - Fax:480-702-0495
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C51935222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist