Basic Information
| Provider Information | |||||||||
| NPI: | 1568630192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1514 JEFFERSON HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701212422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048424000 | ||||||||
| FaxNumber: | 2253812579 | ||||||||
| Practice Location | |||||||||
| Address1: | 8150 JEFFERSON HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708097715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253363100 | ||||||||
| FaxNumber: | 2253812579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2008 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | PGY.1.BRGEN-FP | LA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D0.000175 | LA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | P0660 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1-00031-1 | 05 | LA | MEDICAID | 1000311 | 05 | LA | MEDICAID | 02135078 | 05 | MS | MEDICAID | 8DK499 | 01 | TX | BCBS-TX | OTHER | 1568630192 | 01 | TX | TRICARE - SOUTH | OTHER |