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NPI Code Detail

MEDICARE: DOUGLAS G WYSHAM MD

MEDICARE: DOUGLAS G WYSHAM MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease PhysicianMD00029442WA
2207RI0011XInterventional Cardiology PhysicianMD00029442WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275526360
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS G WYSHAM MD
Provider Business Mailing Address
First Line : PO BOX 873010
Second Line :
City : VANCOUVER
State : WA
Zip : 98687-3010
Country : US
Telephone Number : 360-882-2778
Fax Number : 360-604-1771
Provider Business Practice Location Address
First Line : 700 NE 87TH AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98664-1913
Country : US
Telephone Number : 360-882-3662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 11/07/2016

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