Healthcare Provider Details

I. General information

NPI: 1063321180
Provider Name (Legal Business Name): ELIAS G RAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 W JACKSON ST
PENSACOLA FL
32505-7552
US

IV. Provider business mailing address

2315 W JACKSON ST
PENSACOLA FL
32505-7552
US

V. Phone/Fax

Practice location:
  • Phone: 850-436-4630
  • Fax: 850-436-2095
Mailing address:
  • Phone: 850-436-4630
  • Fax: 850-436-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW23861
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: