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General NPI Number Information
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NPI Number | 1356670335
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Entity Type | Organization
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Legal Business Name | BOB K. WYNN, M.D. P.A.
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 296 US HIGHWAY BUSINESS 96
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City | BUNA
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State | TX
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Zip | 77612-0437
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Country | US
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Telephone | 409-994-2427
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Fax | 409-994-3132
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Provider Business Mailing Address
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Address Line | PO BOX 1270
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City | BUNA
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State | TX
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Zip | 77612-1270
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Country | US
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Telephone | 409-994-2427
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Fax | 409-994-3132
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Authorized Official
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Title or Position | OWNER
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Name | DR. BOB K. WYNN
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Credential | M.D.
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Telephone | 409-994-2427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F2723
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License Number State | TX
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