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General NPI Number Information
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NPI Number | 1548216195
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Entity Type | Individual
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Provider Name | RAYMOND B. WYNN MD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 2500 WEST 12TH STREET UPMC REGIONAL CANCER CENTER
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City | ERIE
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State | PA
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Zip | 16505
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Country | US
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Telephone | 708-635-9133
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Fax |
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Provider Business Mailing Address
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Address Line | 125 OAK RIDGE DR E
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City | BURR RIDGE
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State | IL
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Zip | 60527-6869
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Country | US
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Telephone | 87-635-9133
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Fax |
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD438611
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 036142602
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License Number State | IL
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