Provider Demographics
NPI:1407838949
Name:WIEN, WILLIAM ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALAN
Last Name:WIEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22405 5TH PL W
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9709
Mailing Address - Country:US
Mailing Address - Phone:360-331-4424
Mailing Address - Fax:360-331-1679
Practice Address - Street 1:1689 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249
Practice Address - Country:US
Practice Address - Phone:360-331-4424
Practice Address - Fax:360-331-1679
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2850WIOtherBLUE SHIELD
WA8870738OtherPTAN
WA162276OtherLABOR & INDUSTRIES
WAE80026Medicare UPIN