Provider Demographics
NPI:1922174705
Name:RAY ANDREW, MD, PC
Entity Type:Organization
Organization Name:RAY ANDREW, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-259-4466
Mailing Address - Street 1:2700 S HIGHWAY 191 STE 2
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-3443
Mailing Address - Country:US
Mailing Address - Phone:435-259-4466
Mailing Address - Fax:435-259-4467
Practice Address - Street 1:2700 S HIGHWAY 191 STE 2
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-3443
Practice Address - Country:US
Practice Address - Phone:435-259-4466
Practice Address - Fax:435-259-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5160918-0144261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT558752212-004Medicaid
UTQM0000071700OtherALTIUS PROVIDER NUMBER
UT5141202-1205OtherSTATE LICENSE NUMBER
UT107012421102OtherSELECT HEALTH PROVIDER #
UT755227OtherDMBA PROVIDER #
UT51412021201001OtherBLUE CROSS BLUE SHIELD
UT68474OtherPEHP PROVIDER NUMBER
UT68474OtherPEHP PROVIDER NUMBER
UTBA7037799OtherDEA NUMBER
UTQM0000071700OtherALTIUS PROVIDER NUMBER