Provider Demographics
NPI:1275952541
Name:RAY, MATTHEW S (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:RAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 5TH AVE # 4N
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1334
Mailing Address - Country:US
Mailing Address - Phone:509-342-3915
Mailing Address - Fax:509-342-3916
Practice Address - Street 1:400 E 5TH AVE # 4N
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1334
Practice Address - Country:US
Practice Address - Phone:509-342-3915
Practice Address - Fax:509-342-3916
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60645891207R00000X, 207RN0300X
COTL.0007356390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty