Provider Demographics
NPI:1689659534
Name:RAY, THOMAS CLIFFORD (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CLIFFORD
Last Name:RAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 13TH AVE SE
Mailing Address - Street 2:STE A
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4359
Mailing Address - Country:US
Mailing Address - Phone:256-355-9216
Mailing Address - Fax:256-351-6327
Practice Address - Street 1:1304 13TH AVE SE
Practice Address - Street 2:STE A
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4359
Practice Address - Country:US
Practice Address - Phone:256-355-9216
Practice Address - Fax:256-351-6327
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL14320207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51018984OtherBLUE CROSS BLUE SHIELD
AL52930017Medicaid
AL51018984OtherBLUE CROSS BLUE SHIELD
ALD578Medicare PIN