Provider Demographics
NPI:1275553513
Name:KOMRAY, RAYMOND ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ROBERT
Last Name:KOMRAY
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 1:1365 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1837
Mailing Address - Country:US
Mailing Address - Phone:231-739-9095
Mailing Address - Fax:231-739-6439
Practice Address - Street 1:1365 MERCY DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1837
Practice Address - Country:US
Practice Address - Phone:231-739-9095
Practice Address - Fax:231-739-6439
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRK039403OtherBCBS REFERRING PRO ID NO.
MI105115OtherPREFERRED CHOICE PRO ID
MI0610450OtherBCBS PROV ID NO
MI1517752Medicaid
MIP55690OtherBLUE CARE NETWORK PRO ID
MIP55690OtherBLUE CARE NETWORK PRO ID
MI105115OtherPREFERRED CHOICE PRO ID
MI1517752Medicaid