Provider Demographics
NPI:1982775995
Name:RAY, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RAY
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 1:517 MISTY LN
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-3033
Mailing Address - Country:US
Mailing Address - Phone:330-670-9063
Mailing Address - Fax:
Practice Address - Street 1:60 SOUTH PLEASANT STREET
Practice Address - Street 2:SUITE B
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1633
Practice Address - Country:US
Practice Address - Phone:440-774-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066948204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine