Provider Demographics
NPI:1124066741
Name:LABOY ESPADA, RAY R (MD)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:R
Last Name:LABOY ESPADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 H ST EAST
Mailing Address - Street 2:DHHS-IHS-POPLAR HEALTH CLINIC
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255
Mailing Address - Country:US
Mailing Address - Phone:406-768-2150
Mailing Address - Fax:406-768-3603
Practice Address - Street 1:107 H ST EAST
Practice Address - Street 2:DHHS-IHS-POPLAR HEALTH CLINIC
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255
Practice Address - Country:US
Practice Address - Phone:406-768-2150
Practice Address - Fax:406-768-3603
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15042207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-64182Medicare UPIN