Healthcare Provider Details

I. General information

NPI: 1992348619
Provider Name (Legal Business Name): DERMATOLOGY CLINIC OF SPOKANE, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E FARWELL RD STE 206
SPOKANE WA
99218-8208
US

IV. Provider business mailing address

309 E FARWELL RD STE 206
SPOKANE WA
99218-8208
US

V. Phone/Fax

Practice location:
  • Phone: 509-484-4591
  • Fax: 509-484-7882
Mailing address:
  • Phone: 509-484-4591
  • Fax: 509-484-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM ANDREW WRAY
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 509-484-4591