Healthcare Provider Details

I. General information

NPI: 1245301795
Provider Name (Legal Business Name): JOANNE M RAY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S TELSHOR BLVD BLDG S SUITE 202
LAS CRUCES NM
88011-4688
US

IV. Provider business mailing address

755 S TELSHOR BLVD BLDG S SUITE 202
LAS CRUCES NM
88011-4688
US

V. Phone/Fax

Practice location:
  • Phone: 505-532-5912
  • Fax: 505-532-5915
Mailing address:
  • Phone: 505-532-5912
  • Fax: 505-532-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA105096
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: