Healthcare Provider Details

I. General information

NPI: 1013959030
Provider Name (Legal Business Name): GEORGE EDWARD RAY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3134-A CALHOUN STREET
NEW ORLEANS LA
70125-4202
US

IV. Provider business mailing address

3134-A CALHOUN STREET
NEW ORLEANS LA
70125-4202
US

V. Phone/Fax

Practice location:
  • Phone: 504-861-0108
  • Fax: 504-861-0112
Mailing address:
  • Phone: 504-861-0108
  • Fax: 504-861-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM.200035
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: