Healthcare Provider Details

I. General information

NPI: 1730568114
Provider Name (Legal Business Name): KYLE RATTRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N LIDGERWOOD ST STE 126
SPOKANE WA
99208-1122
US

IV. Provider business mailing address

12606 E MISSION AVE
SPOKANE VALLEY WA
99216-3421
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8200
  • Fax: 509-434-0392
Mailing address:
  • Phone: 509-924-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60763716
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22519
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60763716
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: