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General NPI Number Information
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NPI Number | 1548215197
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Entity Type | Individual
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Provider Name | WESLEY D WYLIE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 280 RIVER PARK DR SUITE 350
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City | PROVO
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State | UT
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Zip | 84604-5764
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Country | US
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Telephone | 801-380-0432
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Fax | 801-802-0108
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Provider Business Mailing Address
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Address Line | 1027 OAKRIDGE RD S
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City | PARK CITY
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State | UT
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Zip | 84098-5615
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Country | US
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Telephone | 801-380-0432
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Fax | 801-802-0108
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 187190-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | M-12076
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M-12076
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License Number State | ID
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