MEDICARE: ALLYSON M RAY MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	97-130	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NM012015	OTHER	NM	BCBS PIN NUMBER

General Provider Information

NPI Number	:	1205969300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLYSON M RAY MD PC

Provider Business Mailing Address
First Line	:	1020 TIJERAS AVE NE STE 22
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4749
Country	:	US
Telephone Number	:	505-848-3124
Fax Number	:	505-848-8077

Provider Business Practice Location Address
First Line	:	1020 TIJERAS AVE NE STE 22
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4749
Country	:	US
Telephone Number	:	505-848-3124
Fax Number	:	505-848-8077

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ALLYSON M RAY
Credential	:	MD
Telephone Number	:	505-848-3124

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	08/22/2020

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Directions to “ALLYSON M RAY MD PC ” Practice Location

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