Provider Demographics
NPI:1710978630
Name:DRAIN, KERRY L (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:L
Last Name:DRAIN
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 1:508 W 6TH AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2770
Mailing Address - Country:US
Mailing Address - Phone:509-747-1624
Mailing Address - Fax:
Practice Address - Street 1:1330 N WASHINGTON ST STE 4200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2476
Practice Address - Country:US
Practice Address - Phone:509-747-1624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040983207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA030005405OtherRAILROAD MEDICARE
ID807097100OtherIDAHO MEDICAID
WA7042560OtherAETNA
WA0193872OtherL & I
WA8319071Medicaid
WA7042560OtherAETNA
WA030005405OtherRAILROAD MEDICARE