Provider Demographics
NPI:1942395801
Name:RAY, JASON SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SCOTT
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:PO BOX 2706
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73802-2706
Mailing Address - Country:US
Mailing Address - Phone:580-334-8568
Mailing Address - Fax:580-256-8000
Practice Address - Street 1:915 17TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2447
Practice Address - Country:US
Practice Address - Phone:580-334-8568
Practice Address - Fax:580-256-8000
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100096750AMedicaid
OK100096750AMedicaid
OKOK401295Medicare PIN