13D2306016 CLIA NUMBER - WRAY DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 13D2306016
  • Facility Name: WRAY DERMATOLOGY
  • Facility Address: 500 S 11TH AVE STE 301
    POCATELLO, ID
    ZIP 83201
  • Facility Phone: 986 228-8765
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: ADAM D. WRAY
  • NPI Number: 1457110298
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 13D2306016
LAB Type Physician Office
Facility Name WRAY DERMATOLOGY
Street 500 S 11TH AVE STE 301
City POCATELLO
State ID
ZIP 83201
Phone 986 228-8765
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 6/5/2025
Certificate Expiration Date 6/4/2027
Facility Type Physician Office
Lab Director ADAM D. WRAY

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This page was last updated on: 9/29/2025