Provider Demographics
NPI:1093726481
Name:SCOTT L RAY DO PA
Entity type:Organization
Organization Name:SCOTT L RAY DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-797-3155
Mailing Address - Street 1:2350 SUNSET POINT RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1443
Mailing Address - Country:US
Mailing Address - Phone:727-797-3155
Mailing Address - Fax:727-797-4301
Practice Address - Street 1:2350 SUNSET POINT RD
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1443
Practice Address - Country:US
Practice Address - Phone:727-797-3155
Practice Address - Fax:727-797-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOSOOO4600207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069515700Medicaid
FL069515700Medicaid
FLD60675Medicare UPIN