Individual
DR. DERRIS WAYNE RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
309 WALNUT ST, STE D, AMITE, LA 70422-2055
(985) 748-5158
(985) 748-9942
Mailing address
309 WALNUT ST, STE D, AMITE, LA 70422-2055
(985) 748-5158
(985) 748-9942
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
14423
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306533
—
LA
Enumeration date
09/15/2005
Last updated
07/24/2019
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