Provider Demographics
NPI:1891759759
Name:RAY, JACQUELINE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:R
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 1:2915 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1401
Mailing Address - Country:US
Mailing Address - Phone:304-691-8900
Mailing Address - Fax:304-525-6238
Practice Address - Street 1:2915 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1401
Practice Address - Country:US
Practice Address - Phone:304-525-6235
Practice Address - Fax:304-525-6238
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64942964Medicaid
OH2134747Medicaid
WV0111707000Medicaid
OH2134747Medicaid