Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 5101010643 | MI |
NPI | 1003867136 |
---|---|
Provider Name | Dr. Clarence C. Rayos |
First Address | Dearborn, MI 48126-2641 |
Second Address | Dearborn, MI 48126-2641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 11/04/2013 |