Individual
JONATHAN DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16811 SE MCGILLIVRAY BLVD, VANCOUVER, WA 98683-3404
(360) 735-8100
(360) 735-3400
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
(360) 735-8100
(360) 735-3400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00036202
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8236242
—
WA
Enumeration date
07/14/2006
Last updated
02/29/2016
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