Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 53745 | CO |
NPI | 1346228889 |
---|---|
Provider Name | John D Ray |
First Address | Fort Collins, CO 80528-5119 |
Second Address | Fort Collins, CO 80528-5119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 16/06/2015 |