=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144480666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUGLAS E WRUNG MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2008
-----------------------------------------------------
Last Update Date | 06/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 FRANKLIN AVE
-----------------------------------------------------
City | SUNNYSIDE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98944-2252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-839-4555
-----------------------------------------------------
Fax | 509-839-0189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 FRANKLIN AVE
-----------------------------------------------------
City | SUNNYSIDE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98944-2252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-839-4555
-----------------------------------------------------
Fax | 509-839-0189
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. CONNIE J FARR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-839-4555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD0026187
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------