Provider Demographics
NPI:1679785778
Name:RAY, DARRIN (MD)
Entity type:Individual
Prefix:
First Name:DARRIN
Middle Name:
Last Name:RAY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1000
Mailing Address - Country:US
Mailing Address - Phone:888-331-3239
Mailing Address - Fax:888-331-3239
Practice Address - Street 1:120 W 19TH ST
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1000
Practice Address - Country:US
Practice Address - Phone:815-566-9915
Practice Address - Fax:888-661-3051
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370647938016Medicaid