Individual
DR. MARY E WUNDERLE-MCINTOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
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
207Q00000X
Family Medicine Physician
4301074863
MI
207Q00000X
Family Medicine Physician
Primary
MD29024
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4116612
—
MI
Enumeration date
02/13/2006
Last updated
11/10/2020
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