Individual
VANESSA GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 W 8TH AVE, SPOKANE, WA 99204-2307
(509) 474-3260
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
BP10041330
TX
207R00000X
Internal Medicine Physician
Primary
MD60633001
WA
207R00000X
Internal Medicine Physician
P8356
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01374101
RR MEDICARE
TX
Enumeration date
05/26/2011
Last updated
07/25/2016
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