Provider Demographics
NPI:1376616771
Name:RAY, LORI A (MD)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:254 REN MAR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-3722
Mailing Address - Country:US
Mailing Address - Phone:615-746-0203
Mailing Address - Fax:615-746-0001
Practice Address - Street 1:254 REN MAR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-3722
Practice Address - Country:US
Practice Address - Phone:615-746-0203
Practice Address - Fax:615-746-0001
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2012-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD35703207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38746771Medicaid
TN4038189OtherBLUE CROSS BLUE SHIELD PR
TN4038189OtherBLUE CROSS BLUE SHIELD PR
TN38746771Medicare PIN