Provider Demographics
NPI:1700943362
Name:RAY, DOROTHY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:MARIE
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:DOROTHY
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 602
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7601
Mailing Address - Country:US
Mailing Address - Phone:949-644-1434
Mailing Address - Fax:949-644-0192
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 602
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-644-1434
Practice Address - Fax:949-644-0192
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-18042207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA21155Medicare UPIN
CAW10619Medicare ID - Type Unspecified