Healthcare Provider Details

I. General information

NPI: 1982990297
Provider Name (Legal Business Name): COLIN ELLIOTT WOLSLEGEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 GEORGIANA ST
PORT ANGELES WA
98362-3911
US

IV. Provider business mailing address

PO BOX 850
PORT ANGELES WA
98362-0146
US

V. Phone/Fax

Practice location:
  • Phone: 360-565-0999
  • Fax: 360-565-9251
Mailing address:
  • Phone: 360-565-9237
  • Fax: 360-565-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOP60738862
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: