Provider Demographics
NPI:1871681999
Name:RAY, KEREN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:KEREN
Middle Name:ELIZABETH
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 SIEGEN LN STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-4589
Mailing Address - Country:US
Mailing Address - Phone:225-612-3403
Mailing Address - Fax:225-612-3404
Practice Address - Street 1:6725 SIEGEN LN STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4589
Practice Address - Country:US
Practice Address - Phone:225-612-3403
Practice Address - Fax:225-612-3404
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200816208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1582514Medicaid
LA4K344D279Medicare PIN
LA4M636DX04Medicare PIN
LA4M636D279Medicare PIN
LA1582514Medicaid