Provider Demographics
NPI:1922002666
Name:RAY, TROY DOUGLAS (CRNA)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:DOUGLAS
Last Name:RAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1318
Mailing Address - Country:US
Mailing Address - Phone:540-489-6353
Mailing Address - Fax:540-484-8552
Practice Address - Street 1:180 FLOYD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1318
Practice Address - Country:US
Practice Address - Phone:540-489-6353
Practice Address - Fax:540-484-8552
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12070367500000X, 367500000X
TNRN156847367500000X
VA0024165499367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010006741Medicaid
VA010006741Medicaid