Provider Demographics
NPI:1477662286
Name:RAY, THOMAS F (CRNA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:RAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7240 MACKENZIE LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4414
Mailing Address - Country:US
Mailing Address - Phone:269-321-9090
Mailing Address - Fax:269-321-9098
Practice Address - Street 1:7240 MACKENZIE LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4414
Practice Address - Country:US
Practice Address - Phone:269-321-9090
Practice Address - Fax:269-321-9098
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9207723367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered