Provider Demographics
NPI:1992348619
Name:DERMATOLOGY CLINIC OF SPOKANE, P.C
Entity type:Organization
Organization Name:DERMATOLOGY CLINIC OF SPOKANE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-484-4591
Mailing Address - Street 1:309 E FARWELL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-8208
Mailing Address - Country:US
Mailing Address - Phone:509-484-4591
Mailing Address - Fax:509-484-7882
Practice Address - Street 1:309 E FARWELL RD STE 206
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-8208
Practice Address - Country:US
Practice Address - Phone:509-484-4591
Practice Address - Fax:509-484-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty