Provider Demographics
NPI:1689620767
Name:WOODMANSEE, RAY K (MD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:K
Last Name:WOODMANSEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 WEST 32ND STREET
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-347-1111
Mailing Address - Fax:417-347-2149
Practice Address - Street 1:1102 WEST 32ND STREET
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-347-1111
Practice Address - Fax:417-347-2149
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106089207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO024050147OtherMEDICARE
MO243419306Medicaid
MO204642102OtherMEDICAID
F39137Medicare UPIN
MO204642102OtherMEDICAID