Basic Information
Provider Information
NPI: 1306138474
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAY
FirstName: WILLIAM
MiddleName: WALTER
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9231 EMERALD WOODS WAY
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379224258
CountryCode: US
TelephoneNumber: 4233308330
FaxNumber:  
Practice Location
Address1: 1924 ALCOA HWY
Address2: DEPARTMENT OF INTERNAL MEDICINE / U-114
City: KNOXVILLE
State: TN
PostalCode: 379201511
CountryCode: US
TelephoneNumber: 8653059340
FaxNumber: 8563059144
Other Information
ProviderEnumerationDate: 05/09/2011
LastUpdateDate: 05/09/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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