Provider Demographics
NPI:1346200433
Name:RAY, MUKUNDA BIHARY (MD)
Entity Type:Individual
Prefix:
First Name:MUKUNDA
Middle Name:BIHARY
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 840294
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0294
Mailing Address - Country:US
Mailing Address - Phone:888-344-1160
Mailing Address - Fax:972-331-3148
Practice Address - Street 1:4207 E COTTON CENTER BLVD.
Practice Address - Street 2:BUILDING 10
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040
Practice Address - Country:US
Practice Address - Phone:888-276-2223
Practice Address - Fax:972-767-0225
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31401207ZP0101X
AZ37505207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64-862048Medicaid
KY0285220Medicare ID - Type Unspecified
KY64-862048Medicaid