Provider Demographics
NPI:1568996445
Name:YUAN, ALEX RAY (DO)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:RAY
Last Name:YUAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RUI
Other - Middle Name:
Other - Last Name:YUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3144
Mailing Address - Fax:765-983-3038
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-983-3144
Practice Address - Fax:765-983-3038
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000207P00000X
IN02005903A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine