Provider Demographics
NPI:1194888230
Name:RAY, CLAUDE D (PA)
Entity type:Individual
Prefix:
First Name:CLAUDE
Middle Name:D
Last Name:RAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14189
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-0002
Mailing Address - Country:US
Mailing Address - Phone:423-318-9202
Mailing Address - Fax:423-318-9206
Practice Address - Street 1:1410 DOYAL DR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-6108
Practice Address - Country:US
Practice Address - Phone:423-318-9202
Practice Address - Fax:423-318-9206
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1050363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3661783Medicaid
TN3661783Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
TN3661783Medicaid