Provider Demographics
NPI:1558335760
Name:RAY, DOROTHY JOAN (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JOAN
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:JOAN
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:863-669-1212
Mailing Address - Fax:863-666-6089
Practice Address - Street 1:2140 E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3604
Practice Address - Country:US
Practice Address - Phone:863-669-1212
Practice Address - Fax:863-666-6089
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063449200Medicaid
208514OtherAMERIGROUP
FL10503OtherBLUE CROSS BLUE SHIELD