Healthcare Provider Details

I. General information

NPI: 1346228889
Provider Name (Legal Business Name): JOHN D RAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 BATTLECREEK DR UNIT D
FORT COLLINS CO
80528-5119
US

IV. Provider business mailing address

2021 BATTLECREEK DR UNIT D
FORT COLLINS CO
80528-5119
US

V. Phone/Fax

Practice location:
  • Phone: 970-286-2393
  • Fax: 970-825-5920
Mailing address:
  • Phone: 970-286-2393
  • Fax: 970-825-5920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number53745
License Number StateCO

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: