Healthcare Provider Details

I. General information

NPI: 1083748800
Provider Name (Legal Business Name): DAVID A RAY DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 WOODROW WILSON RAY CIR
BRIDGEPORT TX
76426-2061
US

IV. Provider business mailing address

808 WOODROW WILSON RAY CIR
BRIDGEPORT TX
76426-2061
US

V. Phone/Fax

Practice location:
  • Phone: 940-683-2297
  • Fax: 940-683-2984
Mailing address:
  • Phone: 940-683-2297
  • Fax: 940-683-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDOE2807
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID A RAY
Title or Position: DOCTOR
Credential: DO PA
Phone: 940-683-2297