Provider Demographics
NPI:1376538769
Name:BALYEAT, RAY MORTON (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:MORTON
Last Name:BALYEAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2000 S WHEELING AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5639
Mailing Address - Country:US
Mailing Address - Phone:918-749-2220
Mailing Address - Fax:918-712-9125
Practice Address - Street 1:2000 S WHEELING AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5639
Practice Address - Country:US
Practice Address - Phone:918-749-2220
Practice Address - Fax:918-712-9125
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK14741207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D39343Medicare UPIN