Provider Demographics
NPI:1649246471
Name:RAY, PRANAB (MD)
Entity type:Individual
Prefix:
First Name:PRANAB
Middle Name:
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 1:401 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1131
Mailing Address - Country:US
Mailing Address - Phone:941-807-6166
Mailing Address - Fax:941-748-7878
Practice Address - Street 1:11950 COUNTY ROAD 101
Practice Address - Street 2:SUITE 105
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-9332
Practice Address - Country:US
Practice Address - Phone:352-391-6190
Practice Address - Fax:352-391-6199
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME318912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49060102Medicaid
FL049060100Medicaid
P00422380OtherRAILROAD MEDICARE
41177XMedicare PIN
FL049060100Medicaid
FL49060102Medicaid
FL41177Medicare ID - Type Unspecified