Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 97-130 | NM |
NPI | 1215026497 |
---|---|
Provider Name | Allyson Marie Ray |
First Address | Albuquerque, NM 87106-4749 |
Second Address | Albuquerque, NM 87106-4749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 04/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G28108 | (02) | NM |
NM012015 | BCBS (01) | NM |
Q2915 | (05) | NM |