Provider Demographics
NPI:1689751679
Name:WRUNG, DOUGLAS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EDWARD
Last Name:WRUNG
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:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0957
Mailing Address - Country:US
Mailing Address - Phone:509-839-6822
Mailing Address - Fax:509-839-5913
Practice Address - Street 1:700 S 11TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2243
Practice Address - Country:US
Practice Address - Phone:509-839-6822
Practice Address - Fax:509-839-5913
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0026187207Q00000X
WAMD00026187207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7097108Medicaid
WAGAB10634Medicare Oscar/Certification
WA6AB10634Medicare ID - Type Unspecified
WA7097108Medicaid
WAGAB10635Medicare Oscar/Certification