Provider Demographics
NPI:1245301795
Name:RAY, JOANNE M (DO)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:RAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:755 S TELSHOR BLVD BLDG S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4688
Mailing Address - Country:US
Mailing Address - Phone:505-532-5912
Mailing Address - Fax:505-532-5915
Practice Address - Street 1:755 S TELSHOR BLVD BLDG S
Practice Address - Street 2:SUITE 202
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4688
Practice Address - Country:US
Practice Address - Phone:505-532-5912
Practice Address - Fax:505-532-5915
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2012-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMA105096208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG32384Medicare UPIN
NMJ6791Medicare ID - Type Unspecified