Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 036.110065 | IL |
NPI | 1265419188 |
---|---|
Provider Name | Dr. Stephen Paul Ray |
First Address | Zion, IL 60099 |
Second Address | Chicago, IL 60674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 27/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B72414 | (02) | IL |