Provider Demographics
NPI:1790855112
Name:PRICE, RAY CARROLL (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:CARROLL
Last Name:PRICE
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:PO BOX 82697
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85071-2697
Mailing Address - Country:US
Mailing Address - Phone:602-787-1327
Mailing Address - Fax:602-787-1634
Practice Address - Street 1:6025 N 20TH AVE
Practice Address - Street 2:PHOENIX BAPTIST HOSPITAL
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:602-249-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11917207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22311501Medicaid
AZ22311501Medicaid