Provider Demographics
NPI:1467500959
Name:GARY L. RAY, MD, INC.
Entity Type:Organization
Organization Name:GARY L. RAY, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-867-2730
Mailing Address - Street 1:PO BOX 63-5491
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5491
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2014582Medicaid
OHMC9291541Medicare ID - Type Unspecified