Provider Demographics
NPI:1245209394
Name:WRAY, WILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:WRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 N LIDGERWOOD ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5095
Mailing Address - Country:US
Mailing Address - Phone:509-484-4591
Mailing Address - Fax:509-474-7882
Practice Address - Street 1:5901 N LIDGERWOOD ST
Practice Address - Street 2:SUITE 118
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5095
Practice Address - Country:US
Practice Address - Phone:509-484-4591
Practice Address - Fax:509-484-7882
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00030912MD173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124353Medicaid
WAG8866647OtherMEDICARE
WAG8866647OtherMEDICARE
WAG8866647Medicare PIN