Provider Demographics
NPI:1215026497
Name:RAY, ALLYSON MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MARIE
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 TIJERAS AVE NE STE 22
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4749
Mailing Address - Country:US
Mailing Address - Phone:505-848-3124
Mailing Address - Fax:
Practice Address - Street 1:1020 TIJERAS AVE NE STE 22
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4749
Practice Address - Country:US
Practice Address - Phone:505-848-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-130174400000X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM012015OtherBCBS
NMQ2915Medicaid
NMQ2915Medicaid
NMNM012015OtherBCBS