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General NPI Number Information
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NPI Number | 1437451457
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Entity Type | Organization
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Legal Business Name | R. CHARLES RAY, MD, LLC
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 65-1227A OPELO RD SUITE104
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City | KAMUELA
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State | HI
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Zip | 96743-7315
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Country | US
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Telephone | 808-885-6030
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Fax | 808-885-6020
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Provider Business Mailing Address
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Address Line | 65-1227A OPELO RD SUITE104
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City | KAMUELA
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State | HI
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Zip | 96743-7315
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Country | US
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Telephone | 808-885-6030
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Fax | 808-885-6020
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Authorized Official
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Title or Position | PARTNER
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Name | DR. RAYMOND CHARLES RAY
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Credential | MD
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Telephone | 808-960-2363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD 15425
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License Number State | HI
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