Provider Demographics
NPI:1346871746
Name:DERRIS W RAY
Entity Type:Organization
Organization Name:DERRIS W RAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-748-5158
Mailing Address - Street 1:309 WALNUT ST STE D
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-2039
Mailing Address - Country:US
Mailing Address - Phone:985-748-5158
Mailing Address - Fax:985-748-9942
Practice Address - Street 1:309 WALNUT ST STE D
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2039
Practice Address - Country:US
Practice Address - Phone:985-748-5158
Practice Address - Fax:985-748-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty