Healthcare Provider Details

I. General information

NPI: 1720056245
Provider Name (Legal Business Name): DAVID E WISNER M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 BIRCHWOOD AVE
BELLINGHAM WA
98225-1781
US

IV. Provider business mailing address

500 BIRCHWOOD AVE SUITE C
BELLINGHAM WA
98225-1704
US

V. Phone/Fax

Practice location:
  • Phone: 360-676-1610
  • Fax: 360-676-2459
Mailing address:
  • Phone: 360-676-1610
  • Fax: 360-676-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00016552025209
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: