1477531853 NPI number — DR. LINDA J RAY MD

Table of content: DR. LINDA J RAY MD (NPI 1477531853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477531853 NPI number — DR. LINDA J RAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAY
Provider First Name:
LINDA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1477531853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
919 HIDDEN RDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75038-3813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-282-2711
Provider Business Mailing Address Fax Number:
469-282-0996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3030 NORTH ST
Provider Second Line Business Practice Location Address:
STE 420
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77702-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-835-2900
Provider Business Practice Location Address Fax Number:
409-835-1350
Provider Enumeration Date:
01/05/2006

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: 207R00000X , with the licence number:  G3721 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 123340505 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123340507 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1K2017 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P02601542 . This is a "MCRR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1K2018 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P02601545 . This is a "MCRR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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