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NPI Code Detail

MEDICARE: EVAN TAYLOR WYTHE MD

MEDICARE: EVAN TAYLOR WYTHE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianG52284CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
200G522840OTHERCABLUE SHIELD

General Provider Information

NPI Number : 1013908433
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN TAYLOR WYTHE MD
Provider Business Mailing Address
First Line : 4301 NORTHSTAR WAY
Second Line :
City : MODESTO
State : CA
Zip : 95356-9262
Country : US
Telephone Number : 209-342-2300
Fax Number : 209-524-4240
Provider Business Practice Location Address
First Line : 20103 LAKE CHABOT RD
Second Line :
City : CASTRO VALLEY
State : CA
Zip : 94546-5341
Country : US
Telephone Number : 209-342-2300
Fax Number : 209-524-4240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 03/08/2026

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Directions to “ EVAN TAYLOR WYTHE MD” Practice Location

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