Provider Demographics
NPI:1477505956
Name:RAY, PETER DAMIAN (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:DAMIAN
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 1:5185 US ROUTE 60 EAST
Mailing Address - Street 2:SUITE 26
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705
Mailing Address - Country:US
Mailing Address - Phone:304-691-8910
Mailing Address - Fax:304-691-1860
Practice Address - Street 1:617 23RD ST STE 105
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2890
Practice Address - Country:US
Practice Address - Phone:606-408-7500
Practice Address - Fax:606-408-6600
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL202952086S0122X
WV263892086S0122X
KYC24112086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051533336OtherBLUE CROSS
AL009936294Medicaid
AL051533342OtherBLUE CROSS
AL009936296Medicaid
AL051533340OtherBLUE CROSS
AL009936297Medicaid
AL009936298Medicaid
AL051533341OtherBLUE CROSS