Provider Demographics
NPI:1922004936
Name:RAY, JOEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:W
Last Name:RAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:150 S MOUNT AUBURN RD
Mailing Address - Street 2:STE 320
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4911
Mailing Address - Country:US
Mailing Address - Phone:573-339-0900
Mailing Address - Fax:573-339-1851
Practice Address - Street 1:150 S MOUNT AUBURN RD
Practice Address - Street 2:STE 320
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4911
Practice Address - Country:US
Practice Address - Phone:573-339-0900
Practice Address - Fax:573-339-1851
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD113702174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208870204Medicaid
MOF04952Medicare UPIN
MO000006529Medicare ID - Type Unspecified