Healthcare Provider Details

I. General information

NPI: 1558578260
Provider Name (Legal Business Name): DAVID K. WYLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2347 E GALA ST
MERIDIAN ID
83642-4881
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-3767
  • Fax: 208-323-3750
Mailing address:
  • Phone: 208-381-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberO-0599
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberO-0599
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberO-0599
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: