MEDICARE: CHARLES E. RAY, M.D. APMC

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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4388804890	OTHER	LA	BLUE CROSS OF LA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750607412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES E. RAY, M.D. APMC

Provider Business Mailing Address
First Line	:	PO BOX 1427
Second Line	:
City	:	JENNINGS
State	:	LA
Zip	:	70546-1427
Country	:	US
Telephone Number	:	337-824-9012
Fax Number	:	337-824-9018

Provider Business Practice Location Address
First Line	:	1910 JOHNSON ST
Second Line	:
City	:	JENNINGS
State	:	LA
Zip	:	70546-3628
Country	:	US
Telephone Number	:	337-824-9012
Fax Number	:	337-824-9018

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	CHARLES E RAY, M.D. APMC
Credential	:	MD
Telephone Number	:	337-824-9012

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	04/20/2010

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