Wyman, Michael Bruce

Wyman, Michael Bruce is an individual health care provider with primary practice located at 5050 Ne Hoyt St Suite 340, Portland OR 97213-2991. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Wyman, Michael Bruce can be contacted via phone (503) 234-9861.

Contact Information

Primary practice address
5050 Ne Hoyt St Suite 340 Portland OR 97213-2991
Fax: (503) 238-0873
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X MD13922 Oregon

Profile Details

NPI number 1104824648
LBN Legal business name Wyman, Michael Bruce
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2005
Last updated Dec 31st, 2007 - about 18 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 1104824648 NPPES
Oregon MEDICAID 202739

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