Provider Demographics
NPI:1407860430
Name:NG, RAY W (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:W
Last Name:NG
Suffix:
Gender:M
Credentials:DPM
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 797846
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-7846
Mailing Address - Country:US
Mailing Address - Phone:972-524-3668
Mailing Address - Fax:
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:SUITE # 2300
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-524-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1070213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120396004Medicaid
TX0034BGMedicare PIN
TX120396004Medicaid