Individual
BENJAMIN WIBONELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 27TH AVE SE, PUYALLUP, WA 98374-1145
(253) 770-9000
(253) 770-9712
Mailing address
PO BOX 1205, PUYALLUP, WA 98371-0231
(253) 770-9000
(253) 770-9712
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD61666933
WA
207YX0901X
Otology & Neurotology Physician
MD61666933
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2338134
—
WA
Enumeration date
04/29/2020
Last updated
08/04/2025
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