Individual
BRIAN P WICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2200 NW MYHRE RD, SILVERDALE, WA 98383-7681
(360) 830-1100
Mailing address
9621 RIDGETOP BLVD NW, SILVERDALE, WA 98383-8502
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
MD00027475
WA
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
MD00027475
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200007065
RAILROAD MEDICARE
—
01
—
4587297
AETNA
—
01
—
75451
LABOR & INDUSTRIES
WA
05
—
8117954
—
WA
01
—
8937342
CRIME VICTIMS COMP
WA
01
—
WI9576
REGENCE BLUE SHIELD
—
Enumeration date
06/21/2006
Last updated
03/07/2023
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