Provider Demographics
NPI:1184158768
Name:BOX, DONALD RAY JR
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:BOX
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DONALD
Other - Middle Name:RAY
Other - Last Name:BOX
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:BOCP, CPOA, CFO
Mailing Address - Street 1:6515 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4878
Mailing Address - Country:US
Mailing Address - Phone:901-530-7458
Mailing Address - Fax:901-795-1738
Practice Address - Street 1:6515 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4878
Practice Address - Country:US
Practice Address - Phone:901-530-7458
Practice Address - Fax:901-795-1738
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN224P00000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter