1609083724 NPI number — MR. BERNARDUS E RAY CFA PA

Table of content: MR. BERNARDUS E RAY CFA PA (NPI 1609083724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609083724 NPI number — MR. BERNARDUS E RAY CFA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAY
Provider First Name:
BERNARDUS
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CFA PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609083724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3313
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY ST LOUIS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39521-3313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-342-3831
Provider Business Mailing Address Fax Number:
985-845-1601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 BROADMOOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROTONDA WEST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33947-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-830-0584
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  CN 2545 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CN2545 . This is a "NAT C OF ASSIST SURGEONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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