Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 8855 | KY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D009409 | AZ |
NPI | 1053541219 |
---|---|
Provider Name | Andrew William Ray |
First Address | Chandler, AZ 85224-1435 |
Second Address | Lexington, KY 40509-8567 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2009 |
Last Update Date | 21/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FR1999549 | DEA# DRUG ENFORCEMENT AGENCY (01) |