Healthcare Provider Details

I. General information

NPI: 1679785778
Provider Name (Legal Business Name): DARRIN RAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 19TH ST
GIBSON CITY IL
60936-1000
US

IV. Provider business mailing address

120 W 19TH ST
GIBSON CITY IL
60936-1000
US

V. Phone/Fax

Practice location:
  • Phone: 815-566-9915
  • Fax: 888-661-3051
Mailing address:
  • Phone: 888-331-3239
  • Fax: 888-331-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036122118
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: