Healthcare Provider Details

I. General information

NPI: 1093906786
Provider Name (Legal Business Name): JASON WYSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-1959
  • Fax: 207-430-4007
Mailing address:
  • Phone: 207-622-1959
  • Fax: 207-430-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD18804
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: