Provider Demographics
NPI:1003856105
Name:RAY, MELISSA LAURA (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAURA
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:A100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:2155 W ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3118
Practice Address - Country:US
Practice Address - Phone:520-742-0414
Practice Address - Fax:520-742-4063
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-02-14
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Provider Licenses
StateLicense IDTaxonomies
AZ29234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71668Medicare PIN