Individual
MR. GARY LEE RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, CRNA
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 713-2555
Mailing address
8105 SLANE CT, CLEMMONS, NC 27012-9181
(336) 778-2117
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
098705
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
047468
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430044435
RR MEDICARE
NC
05
—
8051111
—
NC
Enumeration date
05/23/2005
Last updated
08/04/2009
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