Provider Demographics
NPI:1689672859
Name:RAY, WILLIAM JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:RAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 E COLLEGE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-2484
Mailing Address - Country:US
Mailing Address - Phone:309-807-5356
Mailing Address - Fax:309-807-5291
Practice Address - Street 1:2501 E COLLEGE AVE STE C
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-2484
Practice Address - Country:US
Practice Address - Phone:309-807-5356
Practice Address - Fax:309-807-5291
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-081186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-081186Medicaid
IL5715384OtherBLUE CROSS BLUE SHIELD
545260Medicare ID - Type Unspecified
IL5715384OtherBLUE CROSS BLUE SHIELD
IL036-081186Medicaid