Healthcare Provider Details

I. General information

NPI: 1659339356
Provider Name (Legal Business Name): WILLIAM M WISBECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 13TH ST STE 200
EVERETT WA
98201-1621
US

IV. Provider business mailing address

1717 13TH STREET, SUITE 200
EVERETT WA
98201
US

V. Phone/Fax

Practice location:
  • Phone: 425-297-5590
  • Fax: 425-297-5595
Mailing address:
  • Phone: 425-297-5597
  • Fax: 425-297-5598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberMD00025450
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: