Provider Demographics
NPI:1588196463
Name:LAY, ERICA (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:LAY
Suffix:
Gender:F
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-474-3810
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:105 W 8TH AVE STE 454E
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2318
Practice Address - Country:US
Practice Address - Phone:509-474-3810
Practice Address - Fax:509-598-2125
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS9925208000000X, 207SG0201X
390200000X
WAMD61300233207SG0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program