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General NPI Number Information
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NPI Number | 1811990815
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Entity Type | Individual
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Provider Name | GARY LEE RAY MSN, CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | MEDICAL CENTER BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27157-0001
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Country | US
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Telephone | 336-713-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 8105 SLANE CT
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City | CLEMMONS
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State | NC
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Zip | 27012-9181
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Country | US
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Telephone | 336-778-2117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 098705
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 047468
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License Number State | NC
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