1134469190 NPI number — BOBBY G RAY OD PA

Table of content: (NPI 1134469190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134469190 NPI number — BOBBY G RAY OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOBBY G RAY OD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1134469190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79710-0247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-695-6251
Provider Business Mailing Address Fax Number:
432-224-1500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 N MIDLAND DR STE 404
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79707-3388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-695-6251
Provider Business Practice Location Address Fax Number:
432-224-1500
Provider Enumeration Date:
02/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RAY
Authorized Official First Name:
BOBBY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
432-695-6251

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2132TG , 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: 0010YH . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 316066501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com