Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | DR.0052252 | CO |
N | 207RA0201X | Internist - Allergy & Immunology | DR.0052252 | CO |
N | 207RA0201X | Internist - Allergy & Immunology | MD443963 | PA |
NPI | 1366694424 |
---|---|
Provider Name | Manujendra Ray |
First Address | Tacoma, WA 98405-4265 |
Second Address | Tacoma, WA 98405-4265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2008 |
Last Update Date | 04/05/2021 |