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NPI Code Detail

MEDICARE: DESIREE BURROUGHS-RAY MD

MEDICARE: DESIREE BURROUGHS-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
1208M00000XHospitalist Physician58993TN
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1689060907
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESIREE BURROUGHS-RAY MD
Provider Business Mailing Address
First Line : 4119 C ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-4053
Country : US
Telephone Number : 501-247-2199
Fax Number :
Provider Business Practice Location Address
First Line : REGIONAL ONE HEALTH
Second Line : 877 JEFFERSON AVENUE
City : MEMPHIS
State : TN
Zip : 38103-2807
Country : US
Telephone Number : 901-545-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2015
Last Update Date : 05/07/2020

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