Individual
BRANDON WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3700 WASHINGTON AVE, EVANSVILLE, IN 47714-0541
(812) 485-4000
Mailing address
3700 WASHINGTON AVE, EVANSVILLE, IN 47714-0541
(812) 485-4000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
02004974A
IN
2085R0202X
Diagnostic Radiology Physician
125-049385
IL
2085R0202X
Diagnostic Radiology Physician
2010006706
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300017483
—
IN
Enumeration date
05/04/2007
Last updated
01/23/2023
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