Basic Information
| Provider Information | |||||||||
| NPI: | 1497936439 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OAK HARBOR INTERNAL MEDICINE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 SE IRELAND ST | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982775502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606757678 | ||||||||
| FaxNumber: | 3602790614 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 SE IRELAND ST | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982775502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606757678 | ||||||||
| FaxNumber: | 3602790614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2007 | ||||||||
| LastUpdateDate: | 11/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | BISHOP | ||||||||
| AuthorizedOfficialFirstName: | DOUG | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3606787656 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WHIDBEY ISLAND PUBLIC HOSPITAL DISTRICT | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.