Active NPI
Dean S. Wiese, M.D.
- Internal Medicine Physician
- Olympia, WA
National Provider Identifier
1598799777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD00030693
- Practice address
- 403 Black Hills LN SW Ste a
Olympia, WA 98502-8600 - Phone
- (360) 705-0421
- Fax
- (360) 705-0493
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | MD00030693 | WA | |
| Internal Medicine Physician | 207R00000X | MD00030693 | WA | Primary |
Addresses
Primary practice location
403 Black Hills LN SW Ste a
Olympia, WA 98502-8600
Mailing address
1401 Marvin Rd NE
Suite 307 PMB 266
Lacey, WA 98516-5709
Phone (360) 491-5055
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5007947 | Other | WA | GROUP HEALTH |
| MD00030693 | Other | WA | WA STATE LICENSE |
| 1810019 | Medicaid | WA | |
| 44789 | Other | WA | L&I WORKERS COMP |
| 953646046 | Other | WA | TAX ID |
| WI0066 | Other | WA | BLUE CROSS/BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00030693 | WA | MD | Adult Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263340800000",
"number": "1598799777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 MARVIN RD NE",
"address_2": "SUITE 307 PMB 266",
"city": "LACEY",
"state": "WA",
"postal_code": "985165709",
"telephone_number": "360-491-5055",
"fax_number": "360-491-5890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 BLACK HILLS LN SW STE A",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985028600",
"telephone_number": "360-705-0421",
"fax_number": "360-705-0493"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIESE",
"first_name": "DEAN",
"middle_name": "S.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2010-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "WA",
"license": "MD00030693",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WA",
"license": "MD00030693",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP HEALTH",
"identifier": "5007947",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA STATE LICENSE",
"identifier": "MD00030693",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1810019",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I WORKERS COMP",
"identifier": "44789",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "953646046",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "WI0066",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.