Organization
DERRIS W RAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRSTEN T RAY (OFFICE MANAGER)
(985) 748-5158
Entity
Organization
Contact information
Practice address
309 WALNUT ST STE D, AMITE, LA 70422-2039
(985) 748-5158
(985) 748-9942
Mailing address
309 WALNUT ST STE D, AMITE, LA 70422-2039
(985) 748-5158
(985) 748-9942
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
02/04/2020
Last updated
02/04/2020
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