Provider Demographics
NPI:1619368073
Name:SHROUT, RAY
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:SHROUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 AQUARIUS DR STE 111
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5867
Mailing Address - Country:US
Mailing Address - Phone:205-949-0400
Mailing Address - Fax:205-949-0405
Practice Address - Street 1:234 AQUARIUS DR STE 111
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5867
Practice Address - Country:US
Practice Address - Phone:205-949-0400
Practice Address - Fax:205-949-0405
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALE3723163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice