Provider Demographics
NPI:1184660235
Name:WIEBE, GEORGE E (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:WIEBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NE MOTHER JOSEPH PL
Mailing Address - Street 2:P O BOX 1600
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3200
Mailing Address - Country:US
Mailing Address - Phone:360-514-4325
Mailing Address - Fax:360-514-4336
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:BOX 1600
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-514-4325
Practice Address - Fax:360-514-4336
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA18524174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A08094Medicare UPIN