Provider Demographics
NPI:1295705788
Name:RAY, DOUGLAS S (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:RAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5425
Mailing Address - Country:US
Mailing Address - Phone:602-276-5565
Mailing Address - Fax:
Practice Address - Street 1:7236 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5425
Practice Address - Country:US
Practice Address - Phone:602-276-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ065749Medicaid
AZ20783Medicare ID - Type Unspecified
AZ065749Medicaid
AZE35670Medicare UPIN