Healthcare Provider Details

I. General information

NPI: 1366543860
Provider Name (Legal Business Name): SCOTT WILLIAM WRYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 SIERRA ROSE DR SUITE A
RENO NV
89511-2060
US

IV. Provider business mailing address

635 SIERRA ROSE DR. STE. A
RENO NV
89511-2079
US

V. Phone/Fax

Practice location:
  • Phone: 775-284-8296
  • Fax: 775-332-6583
Mailing address:
  • Phone: 775-284-8296
  • Fax: 775-332-6583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number9377
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number9377
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: