MEDICARE: CLINTON W. RAY P.A.

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	363A00000X	Physician Assistant	PA03593	TX

General Provider Information

NPI Number	:	1518955954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINTON W. RAY P.A.

Provider Business Mailing Address
First Line	:	1202 NASA PKWY
Second Line	:	SUITE 1
City	:	HOUSTON
State	:	TX
Zip	:	77058-3304
Country	:	US
Telephone Number	:	281-494-4832
Fax Number	:	281-494-7399

Provider Business Practice Location Address
First Line	:	1202 NASA PKWY
Second Line	:	SUITE 1
City	:	HOUSTON
State	:	TX
Zip	:	77058-3304
Country	:	US
Telephone Number	:	281-494-4832
Fax Number	:	281-494-7399

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	12/27/2016

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