Provider Demographics
NPI:1902463391
Name:RAY, KYLE DAVID (PA-C)
Entity Type:Individual
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First Name:KYLE
Middle Name:DAVID
Last Name:RAY
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:101 BODIN CIR
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIR
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:707-423-3964
Practice Address - Fax:707-423-9129
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2024-05-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant