Provider Demographics
NPI:1194567511
Name:RAY, COLLIN LUKE (DPM)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:LUKE
Last Name:RAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4536 BAYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-7545
Mailing Address - Country:US
Mailing Address - Phone:208-860-6453
Mailing Address - Fax:
Practice Address - Street 1:3801 BELLEMEADE AVE STE 110
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0111
Practice Address - Country:US
Practice Address - Phone:812-485-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID41000486A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist