Individual
DR. YUDI WIBISONO
Active
Individual
DR. YUDI WIBISONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MRO-1647
ID
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
MRO-1647
ID
2083X0100X
Occupational Medicine Physician
10964114-1204
UT
2083X0100X
Occupational Medicine Physician
Primary
OP61182777
WA
Other
Enumeration date
03/27/2017
Last updated
10/13/2022
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