Provider Demographics
NPI:1598965428
Name:RAY, ERIC ISAAC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ISAAC
Last Name:RAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:731 E SOUTHLAKE BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6377
Mailing Address - Country:US
Mailing Address - Phone:817-898-7277
Mailing Address - Fax:817-527-5119
Practice Address - Street 1:731 E SOUTHLAKE BLVD
Practice Address - Street 2:STE 110
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6377
Practice Address - Country:US
Practice Address - Phone:817-898-7277
Practice Address - Fax:817-527-5119
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM89432081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X9706OtherBCBS OF TEXAS
TXTXB120391Medicare PIN