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NPI Code Detail

MEDICARE: RALPH T WYNN MD

MEDICARE: RALPH T WYNN 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
12085R0202XDiagnostic Radiology Physician234251NY
22085R0202XDiagnostic Radiology PhysicianG3923TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G3923OTHERTXTEXAS MEDICAL BOARD

General Provider Information

NPI Number : 1043297195
Entity Type Code : Individual
Provider Name (Legal Business Name) : RALPH T WYNN MD
Provider Business Mailing Address
First Line : 1845 PRECINCT LINE RD STE 209
Second Line :
City : HURST
State : TX
Zip : 76054-3109
Country : US
Telephone Number : 817-632-5803
Fax Number : 817-632-5803
Provider Business Practice Location Address
First Line : 1845 PRECINCT LINE RD STE 209
Second Line :
City : HURST
State : TX
Zip : 76054-3109
Country : US
Telephone Number : 817-632-5803
Fax Number : 817-632-5803
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 11/19/2020

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Directions to “ RALPH T WYNN MD” Practice Location

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