Provider Demographics
NPI:1518030733
Name:RAY, DAVID W (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:RAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61353 SOUTHGATE RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-6607
Mailing Address - Country:US
Mailing Address - Phone:740-439-4228
Mailing Address - Fax:740-204-0211
Practice Address - Street 1:61353 SOUTHGATE RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-6607
Practice Address - Country:US
Practice Address - Phone:740-439-4228
Practice Address - Fax:740-204-0211
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH34005354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0908334Medicaid
OH000000369833OtherUNICARE
OHP00212500OtherRR MEDICARE
OHANTHEMOther000000369833
OHC05354OtherHEALTHPLAN
OHANTHEMOther000000369833
OHF40158Medicare UPIN
OH0908334Medicaid