Provider Demographics
NPI:1407968001
Name:RAY, GARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:RAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1010 CEREAL AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2776
Mailing Address - Country:US
Mailing Address - Phone:513-867-2730
Mailing Address - Fax:513-867-2840
Practice Address - Street 1:1010 CEREAL AVE STE 212
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2776
Practice Address - Country:US
Practice Address - Phone:513-867-2730
Practice Address - Fax:513-867-2840
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35051763208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0589046Medicaid
OH0566732Medicare PIN
OH0589046Medicaid