MEDICARE: DR. DANA MARIE RAY MD

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	207Q00000X	Family Medicine Physician	036115641	IL

General Provider Information

NPI Number	:	1225051071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANA MARIE RAY MD

Provider Business Mailing Address
First Line	:	151 WEST VILLAGE PARKWAY
Second Line	:
City	:	MT. ZION
State	:	IL
Zip	:	62549
Country	:	US
Telephone Number	:	217-675-7285
Fax Number	:	217-675-7983

Provider Business Practice Location Address
First Line	:	151 WEST VILLAGE PARKWAY
Second Line	:
City	:	MT. ZION
State	:	IL
Zip	:	62549
Country	:	US
Telephone Number	:	217-675-7285
Fax Number	:	217-675-7983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	06/12/2025

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