Healthcare Provider Details

I. General information

NPI: 1356345128
Provider Name (Legal Business Name): LINDA M WRAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16259 SYLVESTER RD SW STE 503
BURIEN WA
98166-3059
US

IV. Provider business mailing address

16259 SYLVESTER RD SW STE 503
BURIEN WA
98166-3059
US

V. Phone/Fax

Practice location:
  • Phone: 206-246-3800
  • Fax: 206-246-3583
Mailing address:
  • Phone: 206-246-3800
  • Fax: 206-246-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number16858
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD00016858
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: