Healthcare Provider Details

I. General information

NPI: 1275952541
Provider Name (Legal Business Name): MATTHEW S RAY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 5TH AVE # 4N
SPOKANE WA
99202-1334
US

IV. Provider business mailing address

400 E 5TH AVE # 4N
SPOKANE WA
99202-1334
US

V. Phone/Fax

Practice location:
  • Phone: 509-342-3915
  • Fax: 509-342-3916
Mailing address:
  • Phone: 509-342-3915
  • Fax: 509-342-3916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0007356
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOP60645891
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOP60645891
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: