Provider Demographics
NPI:1265634257
Name:RALEY, RICHARD ANTHONY (MPS, CCT, CCP)
Entity Type:Individual
Prefix:PROF
First Name:RICHARD
Middle Name:ANTHONY
Last Name:RALEY
Suffix:
Gender:M
Credentials:MPS, CCT, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 OUTLOOK DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2345
Mailing Address - Country:US
Mailing Address - Phone:321-480-3008
Mailing Address - Fax:
Practice Address - Street 1:5302 OUTLOOK DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2345
Practice Address - Country:US
Practice Address - Phone:321-480-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1710I1002X, 1744R1102X, 246RP1900X
FL242T00000X, 246QH0401X, 246XC2901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Not Answered1744R1102XOther Service ProvidersSpecialistResearch Study
Not Answered242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
Not Answered246QH0401XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHemapheresis Practitioner
Not Answered246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Not Answered246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist