Provider Demographics
NPI:1750399275
Name:WAHL, MELVIN M JR (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:M
Last Name:WAHL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MELVIN
Other - Middle Name:M
Other - Last Name:WAHL
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-473-0637
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:1100 GOETHALS DR STE B
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3301
Practice Address - Country:US
Practice Address - Phone:509-942-3080
Practice Address - Fax:509-942-3085
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95817207XS0117X
WAMD00047477207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0242786OtherLABOR & INDUSTRIES
WA8483638Medicaid
WA8878371Medicare PIN