1962667741 NPI number — WILLIAM A. WRAY MD, PLLC

Table of content: (NPI 1962667741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962667741 NPI number — WILLIAM A. WRAY MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM A. WRAY MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOUNTIAN VIEW DERMATOLOGY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962667741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 N LIDGERWOOD ST
Provider Second Line Business Mailing Address:
SUITE 118
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99208-5095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-484-4591
Provider Business Mailing Address Fax Number:
509-484-7882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5901 N LIDGERWOOD ST
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-5095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-484-4591
Provider Business Practice Location Address Fax Number:
509-484-7882
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WRAY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
509-484-4591

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  00030912MD , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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