Provider Demographics
NPI:1750607412
Name:CHARLES E. RAY, M.D. APMC
Entity type:Organization
Organization Name:CHARLES E. RAY, M.D. APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAY, M.D. APMC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-824-9012
Mailing Address - Street 1:PO BOX 1427
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-1427
Mailing Address - Country:US
Mailing Address - Phone:337-824-9012
Mailing Address - Fax:337-824-9018
Practice Address - Street 1:1910 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3628
Practice Address - Country:US
Practice Address - Phone:337-824-9012
Practice Address - Fax:337-824-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4388804890OtherBLUE CROSS OF LA
LA1346110Medicaid
LA1346110Medicaid
LA4388804890OtherBLUE CROSS OF LA