Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 29234 | AZ |
NPI | 1003856105 |
---|---|
Provider Name | Melissa Laura Ray |
First Address | Tucson, AZ 85711-3640 |
Second Address | Tucson, AZ 85741-3118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 14/02/2012 |