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Individual

JULIE L. WYNNE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
999 N CURTIS RD STE 415, BOISE, ID 83706-1334
(208) 302-2600
(208) 302-2625
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
40815
AZ
208600000X
Surgery Physician
MD61046959
WA
2086S0102X
Surgical Critical Care Physician
40815
AZ
2086S0102X
Surgical Critical Care Physician
Primary
MC-2824
ID
2086S0102X
Surgical Critical Care Physician
MD61046959
WA
2086S0127X
Trauma Surgery Physician
40815
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
349220
AZ
Enumeration date
02/27/2006
Last updated
06/05/2024
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