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NPI Code Detail

MEDICARE: DR. EDWIN MACKENZIE WYMAN M.D.

MEDICARE: DR. EDWIN MACKENZIE WYMAN M.D.
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
1207X00000XOrthopaedic Surgery Physician31702CO

General Provider Information

NPI Number : 1730171620
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWIN MACKENZIE WYMAN M.D.
Provider Business Mailing Address
First Line : 1280 N MILDRED RD
Second Line : STE 1
City : CORTEZ
State : CO
Zip : 81321-2212
Country : US
Telephone Number : 970-565-9500
Fax Number : 970-565-9538
Provider Business Practice Location Address
First Line : 1280 N MILDRED RD
Second Line : STE 1
City : CORTEZ
State : CO
Zip : 81321-2212
Country : US
Telephone Number : 970-565-9500
Fax Number : 970-565-9538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 10/04/2007

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