Healthcare Provider Details

I. General information

NPI: 1205969300
Provider Name (Legal Business Name): ALLYSON M RAY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 TIJERAS AVE NE STE 22
ALBUQUERQUE NM
87106-4749
US

IV. Provider business mailing address

1020 TIJERAS AVE NE STE 22
ALBUQUERQUE NM
87106-4749
US

V. Phone/Fax

Practice location:
  • Phone: 505-848-3124
  • Fax: 505-848-8077
Mailing address:
  • Phone: 505-848-3124
  • Fax: 505-848-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number97-130
License Number StateNM

VIII. Authorized Official

Name: DR. ALLYSON M RAY
Title or Position: PHYSICIAN
Credential: MD
Phone: 505-848-3124