Provider Demographics
NPI:1689672859
Name:RAY, WILLIAM JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:RAY
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 1:2005 JACOBSSEN DR
Mailing Address - Street 2:STE A
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6288
Mailing Address - Country:US
Mailing Address - Phone:309-807-5356
Mailing Address - Fax:309-807-5291
Practice Address - Street 1:2005 JACOBSSEN DR
Practice Address - Street 2:STE A
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-807-5356
Practice Address - Fax:309-807-5291
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-081186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5715384OtherBLUE CROSS BLUE SHIELD
IL036-081186Medicaid
545260Medicare ID - Type Unspecified
IL5715384OtherBLUE CROSS BLUE SHIELD
IL036-081186Medicaid