Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | E3414 | AR |
N | 207YP0228X | Pediatric Otolaryngology | E3414 | AR |
Y | 207YP0228X | Pediatric Otolaryngology | MD43893 | TN |
N | 207YP0228X | Pediatric Otolaryngology | ME98192 | FL |
NPI | 1629168117 |
---|---|
Provider Name | Richard Mark Ray |
First Address | Farragut, TN 37934-6664 |
Second Address | Knoxville, TN 37916-2219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 15/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H86604 | (02) | FL |