Healthcare Provider Details

I. General information

NPI: 1104137504
Provider Name (Legal Business Name): AUTUMN JEAN RAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 G RD
GRAND JUNCTION CO
81505-9641
US

IV. Provider business mailing address

PO BOX 1687
GRAND JUNCTION CO
81502-1687
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-0920
  • Fax: 970-257-6251
Mailing address:
  • Phone: 970-257-6200
  • Fax: 970-257-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR72192
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0065208
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: