Provider Demographics
NPI:1609981034
Name:RAY, TERRY WILLIAM (LMP)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:WILLIAM
Last Name:RAY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 W HOOD PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6714
Mailing Address - Country:US
Mailing Address - Phone:509-374-4719
Mailing Address - Fax:509-374-3873
Practice Address - Street 1:7105 W HOOD PL
Practice Address - Street 2:SUITE 103
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6714
Practice Address - Country:US
Practice Address - Phone:509-374-4719
Practice Address - Fax:509-374-3873
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist