Provider Demographics
NPI:1225090194
Name:RAY, ROBERT RUSSELL II (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:RUSSELL
Last Name:RAY
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 WHISPER SOUND CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8532
Mailing Address - Country:US
Mailing Address - Phone:407-383-2236
Mailing Address - Fax:
Practice Address - Street 1:2861 DELANEY AVE STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5409
Practice Address - Country:US
Practice Address - Phone:615-263-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021131367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
E57371AMedicare ID - Type Unspecified