Healthcare Provider Details

I. General information

NPI: 1699723767
Provider Name (Legal Business Name): LYLE R WENDLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 5TH AVE SUITE 205
SPOKANE WA
99204-2823
US

IV. Provider business mailing address

801 W 5TH AVE SUITE 205
SPOKANE WA
99204-2823
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-1187
  • Fax: 509-747-1180
Mailing address:
  • Phone: 509-747-1187
  • Fax: 509-747-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License NumberMD00014384
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: