Basic Information
| Provider Information | |||||||||
| NPI: | 1477505956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | DAMIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5185 US ROUTE 60 EAST | ||||||||
| Address2: | SUITE 26 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046918910 | ||||||||
| FaxNumber: | 3046911860 | ||||||||
| Practice Location | |||||||||
| Address1: | 5185 US RT 60 EAST | ||||||||
| Address2: | SUITE 26 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046918910 | ||||||||
| FaxNumber: | 3046911860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 20295 | AL | N | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 2086S0122X | 26389 | WV | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 009936297 | 05 | AL | MEDICAID | 051533342 | 01 | AL | BLUE CROSS | OTHER | 009936296 | 05 | AL | MEDICAID | 009936298 | 05 | AL | MEDICAID | 051533341 | 01 | AL | BLUE CROSS | OTHER | 051533336 | 01 | AL | BLUE CROSS | OTHER | 051533340 | 01 | AL | BLUE CROSS | OTHER | 009936294 | 05 | AL | MEDICAID |