Provider Demographics
NPI:1134187719
Name:RAY, VERNA GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:VERNA
Middle Name:GAIL
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 COLTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8417
Mailing Address - Country:US
Mailing Address - Phone:901-251-2250
Mailing Address - Fax:901-251-2250
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-251-2250
Practice Address - Fax:901-251-2250
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31451207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3890141Medicaid
TN1509859Medicaid
TN1511850Medicaid
TN38901411Medicare PIN
C89434Medicare UPIN
3890141Medicare ID - Type Unspecified
TN1511850Medicaid
TN3890141Medicaid