Provider Demographics
NPI:1700965118
Name:RAY, RONALD (DNAP, CRNA, FNP, ENP)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:DNAP, CRNA, FNP, ENP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 923
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MT
Mailing Address - Zip Code:59474-0923
Mailing Address - Country:US
Mailing Address - Phone:406-450-3391
Mailing Address - Fax:406-303-0331
Practice Address - Street 1:325 5TH ST S
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-2520
Practice Address - Country:US
Practice Address - Phone:406-450-3391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAPN21215363LF0000X
MT21215367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily