Healthcare Provider Details

I. General information

NPI: 1992960660
Provider Name (Legal Business Name): JEFFREY MICHAEL WOLDRICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13898 NE 28TH ST
VANCOUVER WA
98682-8844
US

IV. Provider business mailing address

13898 NE 28TH ST
VANCOUVER WA
98682-8844
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax:
Mailing address:
  • Phone: 360-882-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD70031294
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD179794
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number163360
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: