Provider Demographics
NPI:1902873425
Name:REAY, PAUL R (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:REAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1797 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3322
Mailing Address - Country:US
Mailing Address - Phone:801-796-5954
Mailing Address - Fax:
Practice Address - Street 1:364 WEST 100 NORTH
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:UT
Practice Address - Zip Code:84535-0308
Practice Address - Country:US
Practice Address - Phone:435-587-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4881191-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H45762Medicare UPIN