Provider Demographics
NPI:1104807411
Name:RAY, RONALD G (DPM PT)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
Last Name:RAY
Suffix:
Gender:M
Credentials:DPM PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 11TH AVE S STE 6
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4654
Mailing Address - Country:US
Mailing Address - Phone:406-761-2222
Mailing Address - Fax:406-761-7219
Practice Address - Street 1:1301 11TH AVE S STE 6
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4654
Practice Address - Country:US
Practice Address - Phone:406-761-2222
Practice Address - Fax:406-761-7219
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT122213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT390793Medicaid
MT390793Medicaid
MTM011004788Medicare PIN
000009571OtherBC
MT390793Medicaid