Healthcare Provider Details

I. General information

NPI: 1669977005
Provider Name (Legal Business Name): JESSICA ELAINE RAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 DEBARR RD STE 230
ANCHORAGE AK
99508-2959
US

IV. Provider business mailing address

2925 DEBARR RD STE 230
ANCHORAGE AK
99508-2959
US

V. Phone/Fax

Practice location:
  • Phone: 907-777-1800
  • Fax: 907-278-2066
Mailing address:
  • Phone: 907-777-1800
  • Fax: 907-278-2066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML60866201
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number178923
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: