Provider Demographics
NPI:1609083724
Name:RAY, BERNARDUS E (CFA PA)
Entity type:Individual
Prefix:MR
First Name:BERNARDUS
Middle Name:E
Last Name:RAY
Suffix:
Gender:M
Credentials:CFA PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3313
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39521-3313
Mailing Address - Country:US
Mailing Address - Phone:228-342-3831
Mailing Address - Fax:985-845-1601
Practice Address - Street 1:15 BROADMOOR RD
Practice Address - Street 2:
Practice Address - City:ROTONDA WEST
Practice Address - State:FL
Practice Address - Zip Code:33947-1901
Practice Address - Country:US
Practice Address - Phone:941-830-0584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1131246ZX2200X
VA0136000230246ZC0007X
FLCN 2545363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCN2545OtherNAT C OF ASSIST SURGEONS