Individual
BRENT E WISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
325 9TH AVE, SEATTLE, WA 98104-2420
(206) 731-3241
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD00037414
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0232197
L&I
WA
05
—
1154543932
—
WA
01
—
460003283
RAILROAD MEDICARE
WA
Enumeration date
05/02/2007
Last updated
01/12/2012
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