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General NPI Number Information
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NPI Number | 1790843316
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Entity Type | Individual
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Provider Name | LAWRENCE M WYNER MD
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 1115 20TH ST SUITE 107
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City | HUNTINGTON
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State | WV
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Zip | 25703-2071
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Country | US
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Telephone | 304-691-1900
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Fax | 304-691-1929
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Provider Business Mailing Address
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Address Line | 1115 20TH STREET SUITE 107
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City | HUNTINGTON
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State | WV
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Zip | 25703
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Country | US
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Telephone | 304-691-1900
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Fax | 304-691-1929
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35059870
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 16680
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License Number State | WV
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