MEDICARE: DR. WILLIAM JOHN RAY M.D.

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	207R00000X	Internal Medicine Physician	036-081186	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5715384	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1689672859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JOHN RAY M.D.

Provider Business Mailing Address
First Line	:	2501 E COLLEGE AVE STE C
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-2484
Country	:	US
Telephone Number	:	309-807-5356
Fax Number	:	309-807-5291

Provider Business Practice Location Address
First Line	:	2501 E COLLEGE AVE STE C
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-2484
Country	:	US
Telephone Number	:	309-807-5356
Fax Number	:	309-807-5291

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/29/2024

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