Provider Demographics
NPI:1356331052
Name:RAY, TRISZA L (DO)
Entity type:Individual
Prefix:
First Name:TRISZA
Middle Name:L
Last Name:RAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TRISZA
Other - Middle Name:LEANN
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3347
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:
Practice Address - Street 1:7858 SOUTH OLYMPIA AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132
Practice Address - Country:US
Practice Address - Phone:918-986-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4143207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200062480 AMedicaid
OK244535006Medicare PIN
OKI46912Medicare UPIN