Provider Demographics
NPI:1669750824
Name:RAY, TAMMY LYNN (LMT)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYNN
Last Name:RAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:NM
Mailing Address - Zip Code:88230-9517
Mailing Address - Country:US
Mailing Address - Phone:575-840-8519
Mailing Address - Fax:
Practice Address - Street 1:1717 W 2ND ST
Practice Address - Street 2:SUITE 116
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-2000
Practice Address - Country:US
Practice Address - Phone:575-840-8519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5227175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath