Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 20A14588 | CA |
Y | 207T00000X | Neurosurgeon | 69415 | CT |
NPI | 1053724880 |
---|---|
Provider Name | Dr. Kevin Ray |
First Address | New Haven, CT 06510-3206 |
Second Address | New Haven, CT 06510-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 17/11/2021 |