MEDICARE: REBECCA RAY CPM

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	176B00000X	Midwife	MW398	FL

General Provider Information

NPI Number	:	1982293866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA RAY CPM

Provider Business Mailing Address
First Line	:	332 E 6TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-4614
Country	:	US
Telephone Number	:	904-570-5792
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 STOCKTON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3521
Country	:	US
Telephone Number	:	904-990-3619
Fax Number	:

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

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	01/14/2021

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