Healthcare Provider Details

I. General information

NPI: 1902596620
Provider Name (Legal Business Name): ADAM GREGORY WYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 E 440 N STE A
VINEYARD UT
84059-8142
US

IV. Provider business mailing address

747 E 440 N STE A
VINEYARD UT
84059-8142
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7883
  • Fax: 801-357-7975
Mailing address:
  • Phone: 801-357-7883
  • Fax: 801-357-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14259675-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: