Provider Demographics
NPI:1871996595
Name:CRAIN, JOHNNY RAY JR (RT (R) (ARRT))
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:RAY
Last Name:CRAIN
Suffix:JR
Gender:M
Credentials:RT (R) (ARRT)
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Mailing Address - Street 1:16 SHEBA PL
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7021
Mailing Address - Country:US
Mailing Address - Phone:916-821-7919
Mailing Address - Fax:505-565-2272
Practice Address - Street 1:311 LOS LENTES RD SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-9224
Practice Address - Country:US
Practice Address - Phone:916-821-7919
Practice Address - Fax:505-565-2272
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
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Provider Licenses
StateLicense IDTaxonomies
NM3252242471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography