MEDICARE: ALLYSON MARIE RAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	97-130	NM
2	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	97-130	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM012015	OTHER	NM	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215026497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON MARIE RAY MD

Provider Business Mailing Address
First Line	:	1020 TIJERAS AVE NE STE 22
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4749
Country	:	US
Telephone Number	:	505-848-3124
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 TIJERAS AVE NE STE 22
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4749
Country	:	US
Telephone Number	:	505-848-3124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	12/04/2012

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Directions to “ ALLYSON MARIE RAY MD” Practice Location

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