Individual
DOUGLAS G WYSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 NE 87TH AVE, VANCOUVER, WA 98664-1913
(360) 882-3662
Mailing address
PO BOX 873010, VANCOUVER, WA 98687-3010
(360) 882-2778
(360) 604-1771
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD00029442
WA
207RI0011X
Interventional Cardiology Physician
Primary
MD00029442
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8135832
—
WA
Enumeration date
08/24/2005
Last updated
11/07/2016
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