Individual
MR. JACKIE RAY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
2007 MEGAN CT, WYLIE, TX 75098
(469) 658-6589
Mailing address
2007 MEGAN CT, WYLIE, TX 75098-6019
(469) 658-6589
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
SA00672
TX
Other
Enumeration date
04/13/2016
Last updated
08/02/2018
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