Provider Demographics
NPI:1942373170
Name:DAVID W RAY LLC
Entity type:Organization
Organization Name:DAVID W RAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-439-4228
Mailing Address - Street 1:61353 SOUTHGATE RD SUITE 6
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9617
Mailing Address - Country:US
Mailing Address - Phone:740-439-4228
Mailing Address - Fax:740-204-0211
Practice Address - Street 1:61353 SOUTHGATE RD STE 6
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-6607
Practice Address - Country:US
Practice Address - Phone:740-439-4228
Practice Address - Fax:740-204-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDD1780OtherRR MEDICARE
OHDD1780OtherRR MEDICARE
OH=========00OtherOHIO BWC
OHDD1780OtherRR MEDICARE