Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 51028 | MA |
NPI | 1346238979 |
---|---|
Provider Name | Mr. Alex Henry Ray |
First Address | Needham, MA 02492-2497 |
Second Address | Needham, MA 02492-2497 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 06/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051028 | TUFTS (01) | |
1067 | PILGRIM (01) | |
3067139 | (05) | MA |
B97698 | (02) |