Healthcare Provider Details

I. General information

NPI: 1922495001
Provider Name (Legal Business Name): RYAN WISLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 24TH ST
ANACORTES WA
98221-2592
US

IV. Provider business mailing address

1211 24TH ST
ANACORTES WA
98221-2562
US

V. Phone/Fax

Practice location:
  • Phone: 360-293-3101
  • Fax:
Mailing address:
  • Phone: 360-293-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD70079162
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number304642
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0061512
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: