# JOHN M WICK

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1982657375
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | M8339 | ID | Yes |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | M-8339 | ID | — |

## Other

- **Enumeration date:** 05/18/2006
- **Last updated:** 10/03/2017