Provider Demographics
NPI:1437451457
Name:R. CHARLES RAY, MD, LLC
Entity Type:Organization
Organization Name:R. CHARLES RAY, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-960-2363
Mailing Address - Street 1:65-1227A OPELO RD
Mailing Address - Street 2:SUITE104
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7315
Mailing Address - Country:US
Mailing Address - Phone:808-885-6030
Mailing Address - Fax:808-885-6020
Practice Address - Street 1:65-1227A OPELO RD
Practice Address - Street 2:SUITE104
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7315
Practice Address - Country:US
Practice Address - Phone:808-885-6030
Practice Address - Fax:808-885-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 15425261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty