MEDICARE: DR. WILLIAM ALAN WIEN DO

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
1	207Q00000X	Family Medicine Physician	OP00001588	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2850WI	OTHER	WA	BLUE SHIELD
2	8870738	OTHER	WA	PTAN
3	162276	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1407838949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM ALAN WIEN DO

Provider Business Mailing Address
First Line	:	22405 5TH PL W
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98021-9709
Country	:	US
Telephone Number	:	360-331-4424
Fax Number	:	360-331-1679

Provider Business Practice Location Address
First Line	:	1689 E MAIN ST
Second Line	:	SUITE 1
City	:	FREELAND
State	:	WA
Zip	:	98249
Country	:	US
Telephone Number	:	360-331-4424
Fax Number	:	360-331-1679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	03/18/2008

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Directions to “ DR. WILLIAM ALAN WIEN DO” Practice Location

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