Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 35066948 | OH |
NPI | 1982775995 |
---|---|
Provider Name | Richard Ray |
First Address | Copley, OH 44321-3033 |
Second Address | Oberlin, OH 44074-1633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |