Provider Demographics
NPI:1811135759
Name:RAY, DAVID MICHAEL (FNP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:RAY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:MICHAEL
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:825 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1634
Mailing Address - Country:US
Mailing Address - Phone:541-955-7246
Mailing Address - Fax:541-471-1928
Practice Address - Street 1:825 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1634
Practice Address - Country:US
Practice Address - Phone:541-955-7246
Practice Address - Fax:541-471-1928
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4099111N00000X
OR201500297NP-PP363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor