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NPI Code Detail

MEDICARE: DOUGLAS JOHN WYLAND MD

MEDICARE: DOUGLAS JOHN WYLAND MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician28429SC
2207XX0005XSports Medicine (Orthopaedic Surgery) Physician28429SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00354702OTHERSCMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699771121
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS JOHN WYLAND MD
Provider Business Mailing Address
First Line : 300 E MCBEE AVE FL 4
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2842
Country : US
Telephone Number : 864-522-8603
Fax Number :
Provider Business Practice Location Address
First Line : 333 S PINE ST
Second Line :
City : SPARTANBURG
State : SC
Zip : 29302-2622
Country : US
Telephone Number : 864-515-7500
Fax Number : 864-515-7501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 11/10/2022

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Directions to “ DOUGLAS JOHN WYLAND MD” Practice Location

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