Wutzke, Jared L

Wutzke, Jared L is an individual health care provider with primary practice located at 401 W Poplar St Psmmc Er, Walla Walla WA 99362-2846. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Wutzke, Jared L can be contacted via phone (509) 522-5802.

Contact Information

Primary practice address
401 W Poplar St Psmmc Er Walla Walla WA 99362-2846
Phone: (509) 522-5802
Fax: (509) 522-5541
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X MD60141552 Washington

Profile Details

NPI number 1225238207
LBN Legal business name Wutzke, Jared L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2007
Last updated Mar 30th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225238207 NPPES
Oregon MEDICAID 500626093
Oregon MEDICAID 1225238207

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