Provider Demographics
NPI:1487732525
Name:RAY, CHARLES EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:RAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1910 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3628
Mailing Address - Country:US
Mailing Address - Phone:337-824-9012
Mailing Address - Fax:337-824-9018
Practice Address - Street 1:1910 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3628
Practice Address - Country:US
Practice Address - Phone:337-824-9012
Practice Address - Fax:337-824-9018
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA16680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA12835OtherLA DHH BOARD OF PHARMACY
LA16680OtherSTATE LICENSE NUMBER
LA721185272OtherTAX ID
LA1346110Medicaid
LA1346110Medicaid
LA1346110Medicaid
LAAR1976414OtherDEA