Provider Demographics
NPI:1972865244
Name:DUMAS, RAY A (LAB TECH)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:A
Last Name:DUMAS
Suffix:
Gender:M
Credentials:LAB TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S 300 E
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-1733
Mailing Address - Country:US
Mailing Address - Phone:801-359-8862
Mailing Address - Fax:801-359-8510
Practice Address - Street 1:144 S. 300 E.
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84054
Practice Address - Country:US
Practice Address - Phone:801-359-8862
Practice Address - Fax:801-359-8510
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1376550566251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1376550566Medicaid