Healthcare Provider Details

I. General information

NPI: 1124373709
Provider Name (Legal Business Name): RAY ANTHONY PRICE LDN, RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 TIGER DR
THIBODAUX LA
70301-4337
US

IV. Provider business mailing address

1434 TIGER DR
THIBODAUX LA
70301-4337
US

V. Phone/Fax

Practice location:
  • Phone: 985-447-0916
  • Fax: 985-447-0920
Mailing address:
  • Phone: 985-447-0916
  • Fax: 985-447-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1357
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: