Provider Demographics
NPI:1629050927
Name:DRAIN, RAY ANTOINE (MD)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:ANTOINE
Last Name:DRAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:ANTOINE
Other - Last Name:DRAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:105 S BRYANT AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6399
Mailing Address - Country:US
Mailing Address - Phone:405-348-3100
Mailing Address - Fax:405-348-6785
Practice Address - Street 1:105 S BRYANT AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6399
Practice Address - Country:US
Practice Address - Phone:405-348-3100
Practice Address - Fax:405-348-6785
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100450AMedicaid
C94874Medicare UPIN