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Individual
DR. CHESTER M WYNN
Active
Individual
DR. CHESTER M WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
C8165
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120617001
—
AR
01
—
55003
BLUE CROSS BLUE SHIELD
AR
Enumeration date
04/18/2008
Last updated
04/18/2017
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