Healthcare Provider Details

I. General information

NPI: 1609936210
Provider Name (Legal Business Name): REBA RAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD
LUKE AFB AZ
85309-1529
US

IV. Provider business mailing address

5425 E CAMELHILL RD
PHOENIX AZ
85018-1909
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-6027
  • Fax:
Mailing address:
  • Phone: 602-840-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24165
License Number StateAZ

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: