Provider Demographics
NPI:1962667741
Name:WILLIAM A. WRAY MD, PLLC
Entity Type:Organization
Organization Name:WILLIAM A. WRAY MD, PLLC
Other - Org Name:MOUNTIAN VIEW DERMATOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-484-4591
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:509-484-7882
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00030912MD173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherEIN