Individual
JOHN R WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
171 N 400 W, C-12, OREM, UT 84057-1909
(801) 224-4550
(801) 224-1057
Mailing address
171 N 400 W, C-12, OREM, UT 84057-1909
(801) 224-4550
(801) 224-1057
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2746431205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DO483
—
UT
Enumeration date
02/28/2006
Last updated
06/26/2019
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