Provider Demographics
NPI:1518955954
Name:RAY, CLINTON W (PA)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:W
Last Name:RAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1202 NASA PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3304
Mailing Address - Country:US
Mailing Address - Phone:281-494-4832
Mailing Address - Fax:281-494-7399
Practice Address - Street 1:1202 NASA PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3304
Practice Address - Country:US
Practice Address - Phone:281-494-4832
Practice Address - Fax:281-494-7399
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03593363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ01208Medicare UPIN
TX8G0339Medicare ID - Type Unspecified