Basic Information
| Provider Information | |||||||||
| NPI: | 1780680736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAY | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 865 LINCOLN RD | ||||||||
| Address2: | STE L10 | ||||||||
| City: | BETTENDORF | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527224159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633559191 | ||||||||
| FaxNumber: | 5633553419 | ||||||||
| Practice Location | |||||||||
| Address1: | 2560 24TH ST | ||||||||
| Address2: | STE 202 | ||||||||
| City: | ROCK ISLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612015390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097940590 | ||||||||
| FaxNumber: | 3097793084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-072047 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 020379 | 01 | HEALTH ALLIANCE | OTHER | 4796890015 | 01 | DMERC | OTHER | 20076 | 01 | IOWA HEALTH SOLUTIONS | OTHER | 97781 | 01 | WELLMARK BC/BS | OTHER | IA0151 | 01 | JOHN DEERE HEALTH PLAN | OTHER | 036072047 | 05 | IL | MEDICAID |