Organization
WHIDBEY MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT L LYCKSELL M.D. (OWNER)
(360) 679-3161
Entity
Organization
Contact information
Practice address
231 SE BARRINGTON DR, SUITE 209, OAK HARBOR, WA 98277-3200
(360) 679-3161
(360) 679-1741
Mailing address
231 SE BARRINGTON DR, SUITE 209, OAK HARBOR, WA 98277-3200
(360) 679-3161
(360) 679-1741
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC9056
RAILROAD MEDICARE
WA
01
—
S57923
BLUE CROSS/SHIELD
WA
Enumeration date
07/26/2005
Last updated
12/04/2009
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