Individual
MR. RUSSELL MATTHEW WIMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
425 N SANTIAM HWY, LEBANON, OR 97355-4361
(541) 451-6960
Mailing address
PO BOX 1193, CORVALLIS, OR 97339-1193
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA189087
OR
Other
Enumeration date
10/03/2018
Last updated
11/04/2020
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