Individual
DR. CHARLES EDWARD RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1910 JOHNSON ST, JENNINGS, LA 70546-3628
(337) 824-9012
(337) 824-9018
Mailing address
1910 JOHNSON ST, JENNINGS, LA 70546-3628
(337) 824-9012
(337) 824-9018
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16680
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12835
LA DHH BOARD OF PHARMACY
LA
05
—
1346110
—
LA
01
—
16680
STATE LICENSE NUMBER
LA
01
—
721185272
TAX ID
LA
Enumeration date
11/02/2006
Last updated
10/02/2023
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