MEDICARE: GLADYS WYLES 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
1	207Q00000X	Family Medicine Physician	A71924	CA

General Provider Information

NPI Number	:	1467526236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADYS WYLES MD

Provider Business Mailing Address
First Line	:	2145 5TH AVENUE
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95965
Country	:	US
Telephone Number	:	530-534-3793
Fax Number	:	530-534-3820

Provider Business Practice Location Address
First Line	:	1231 PLUMAS STREET
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991
Country	:	US
Telephone Number	:	530-751-8454
Fax Number	:	530-751-8456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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