Provider Demographics
NPI:1720022874
Name:RAY, MARK K (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:K
Last Name:RAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4340 N JOSEY LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4602
Mailing Address - Country:US
Mailing Address - Phone:972-492-7900
Mailing Address - Fax:972-492-7583
Practice Address - Street 1:4340 N JOSEY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4602
Practice Address - Country:US
Practice Address - Phone:972-492-7900
Practice Address - Fax:972-492-7583
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2013-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH2710207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080611901Medicaid
TXE43897Medicare UPIN
TX080611901Medicaid