Healthcare Provider Details

I. General information

NPI: 1811164478
Provider Name (Legal Business Name): DOUGLAS E WRUNG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 FRANKLIN AVE
SUNNYSIDE CA
98944
US

IV. Provider business mailing address

720 FRANKLIN AVE
SUNNYSIDE CA
98944
US

V. Phone/Fax

Practice location:
  • Phone: 509-839-4555
  • Fax: 509-839-0189
Mailing address:
  • Phone: 509-839-4555
  • Fax: 509-839-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0026187
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD0026187
License Number StateWA

VIII. Authorized Official

Name: DOUGLAS EDWARD WRUNG
Title or Position: PRESIDENT
Credential: MD
Phone: 509-839-4555