Healthcare Provider Details

I. General information

NPI: 1225598220
Provider Name (Legal Business Name): GREGORY EMERSON WYKOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 N REVERE CT # F546
AURORA CO
80045-7464
US

IV. Provider business mailing address

401 E CHESTNUT ST UNIT 610
LOUISVILLE KY
40202-5711
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-6019
  • Fax:
Mailing address:
  • Phone: 502-588-4865
  • Fax: 502-588-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDR.0068864
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: