Provider Demographics
NPI:1811164478
Name:DOUGLAS E WRUNG MD PC
Entity type:Organization
Organization Name:DOUGLAS E WRUNG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WRUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-839-4555
Mailing Address - Street 1:720 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:98944
Mailing Address - Country:US
Mailing Address - Phone:509-839-4555
Mailing Address - Fax:509-839-0189
Practice Address - Street 1:720 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:CA
Practice Address - Zip Code:98944
Practice Address - Country:US
Practice Address - Phone:509-839-4555
Practice Address - Fax:509-839-0189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGLAS E WRUNG MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0026187207VX0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7097108Medicaid
WAGAB10635Medicare Oscar/Certification
WA7097108Medicaid