Provider Demographics
NPI:1629168117
Name:RAY, RICHARD MARK (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARK
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 1:11939 RACELAND WAY
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-6664
Mailing Address - Country:US
Mailing Address - Phone:865-671-1347
Mailing Address - Fax:865-521-6088
Practice Address - Street 1:2100 W CLINCH AVE
Practice Address - Street 2:STE 410
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2219
Practice Address - Country:US
Practice Address - Phone:865-521-6005
Practice Address - Fax:865-521-6088
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME98192207YP0228X
ARE3414207Y00000X, 207YP0228X
TNMD43893207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH86604Medicare UPIN