Provider Demographics
NPI:1417410143
Name:RAY, DARRELL WESLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:WESLEY
Last Name:RAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:645 E MISSOURI AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1351
Mailing Address - Country:US
Mailing Address - Phone:480-500-2540
Mailing Address - Fax:813-254-6440
Practice Address - Street 1:37000 N GANTZEL RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85140-7303
Practice Address - Country:US
Practice Address - Phone:480-394-4066
Practice Address - Fax:480-394-4574
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS17103207P00000X
AZ10471207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS17103OtherFLORIDA BOARD OF OSTEOPATHIC MEDICINE
AZ10471OtherARIZONA BOARD OF OSTEOPATHIC MEDICINE