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NPI Code Detail

MEDICARE: KERRY L DRAIN M.D.

MEDICARE: KERRY L DRAIN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207K00000XAllergy & Immunology PhysicianMD00040983WA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1030005405OTHERWARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
37042560OTHERWAAETNA
40193872OTHERWAL & I
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710978630
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRY L DRAIN M.D.
Provider Business Mailing Address
First Line : 508 W 6TH AVE
Second Line : SUITE 700
City : SPOKANE
State : WA
Zip : 99204-2770
Country : US
Telephone Number : 509-747-1624
Fax Number :
Provider Business Practice Location Address
First Line : 1330 N WASHINGTON ST STE 4200
Second Line :
City : SPOKANE
State : WA
Zip : 99201-2476
Country : US
Telephone Number : 509-747-1624
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 09/27/2021

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Directions to “ KERRY L DRAIN M.D.” Practice Location

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