Provider Demographics
NPI:1679535298
Name:RAY, THADDEUS ALEXAS (DO)
Entity type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:ALEXAS
Last Name:RAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31630
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1630
Mailing Address - Country:US
Mailing Address - Phone:520-784-6200
Mailing Address - Fax:520-784-6109
Practice Address - Street 1:12315 N VISTOSO PARK RD
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-5819
Practice Address - Country:US
Practice Address - Phone:520-784-6200
Practice Address - Fax:520-784-6109
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1463-08208VP0014X
AZ010355208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11553251Medicaid
NMP00896733OtherR R MEDICARE
AZ470441Medicaid
NM7129724OtherAETNA
NM89731034Medicaid
NM202039285OtherPRESBYTERIAN HEALTH PLAN
UT1679535298Medicaid
AZ470441Medicaid
NM202039285OtherPRESBYTERIAN HEALTH PLAN
NMNMA100145Medicare PIN
IAI11820Medicare UPIN
NMP00896733OtherR R MEDICARE