Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 5101015774 | MI |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 005067 | AZ |
NPI | 1750583951 |
---|---|
Provider Name | Dr. Ray Jonathan Lara |
First Address | Tucson, AZ 85718-3179 |
Second Address | Tucson, AZ 85718-3179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 10/10/2016 |