Individual
MR. JOHN ROGER RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
RR 103 SUPPLY STREET, GARY, WV 24836-0507
(304) 448-2101
(304) 448-3217
Mailing address
RR 103 SUPPLY STREET, PO BOX 507, GARY, WV 24836-0507
(304) 448-2101
(304) 448-3217
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1093
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720284
BLUE CROSS/BLUE SHIELD
WV
05
—
0071227000
—
WV
01
—
550674700
STATE TAX DEPARTMENT
WV
Enumeration date
09/19/2005
Last updated
04/21/2011
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