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General NPI Number Information
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NPI Number | 1437113222
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Entity Type | Individual
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Provider Name | CHARLES BRADFORD WYSONG MD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 130 S CENTRAL EXPY WEST PARK MEDICAL CENTER
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City | MCKINNEY
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State | TX
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Zip | 75070-3742
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Country | US
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Telephone | 972-548-5308
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Fax | 972-548-5433
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Provider Business Mailing Address
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Address Line | PO BOX 740968
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City | DALLAS
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State | TX
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Zip | 75374-0968
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Country | US
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Telephone | 800-945-2455
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Fax | 903-453-2541
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | E1192
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License Number State | TX
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