Healthcare Provider Details

I. General information

NPI: 1093726481
Provider Name (Legal Business Name): SCOTT L RAY DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 SUNSET POINT RD SUITE C
CLEARWATER FL
33765-1443
US

IV. Provider business mailing address

2350 SUNSET POINT RD SUITE C
CLEARWATER FL
33765-1443
US

V. Phone/Fax

Practice location:
  • Phone: 727-797-3155
  • Fax: 727-797-4301
Mailing address:
  • Phone: 727-797-3155
  • Fax: 727-797-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOSOOO4600
License Number StateFL

VIII. Authorized Official

Name: DR. SCOTT L RAY
Title or Position: OWNER
Credential: DO
Phone: 727-797-3155