Individual
BRIAN PAUL ROYAL VANWYNGARDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2416 13TH ST SE, SALEM, OR 97302-2546
(503) 798-2918
Mailing address
435 21ST ST SE, SALEM, OR 97301-8848
(612) 638-8449
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
21790
OR
Other
Enumeration date
07/28/2016
Last updated
07/28/2016
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