Provider Demographics
NPI:1477572931
Name:WYMAN, JAMES J (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:WYMAN
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 1:11212 SUNRISE BLVD E STE 201
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8847
Mailing Address - Country:US
Mailing Address - Phone:253-446-0750
Mailing Address - Fax:253-446-0757
Practice Address - Street 1:11212 SUNRISE BLVD E STE 201
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8847
Practice Address - Country:US
Practice Address - Phone:253-446-0750
Practice Address - Fax:253-446-0757
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037260207XX0005X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1477572931Medicaid
WA3240WYOtherREGENCE
WA135267OtherL&I
WA3240WYOtherREGENCE
WA1477572931Medicaid
WA135267OtherL&I