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General NPI Number Information
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NPI Number | 1538133848
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Entity Type | Organization
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Legal Business Name | ROBERT J WYLIE MD PC
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 5078 HIGH DR
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City | LAKESIDE
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State | AZ
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Zip | 85929-5551
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Country | US
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Telephone | 928-242-1162
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Fax | 928-368-9080
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Provider Business Mailing Address
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Address Line | PO BOX 2170
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City | LAKESIDE
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State | AZ
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Zip | 85929-2170
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Country | US
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Telephone | 928-242-1162
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Fax | 928-368-9080
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT J WYLIE
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Credential | MD
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Telephone | 928-242-1162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 18644A
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License Number State | AZ
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