MEDICARE: DR. HOWARD E WYNNE 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
1	174400000X	Specialist	A54852	CA
2	207R00000X	Internal Medicine Physician	A54852	CA

General Provider Information

NPI Number	:	1801808043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD E WYNNE M.D.

Provider Business Mailing Address
First Line	:	2001 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2303
Country	:	US
Telephone Number	:	619-446-1530
Fax Number	:

Provider Business Practice Location Address
First Line	:	3555 KENYON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5341
Country	:	US
Telephone Number	:	619-221-9558
Fax Number	:	619-221-9592

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	01/15/2014

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