Individual
THOMAS WYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1301 33RD ST S, SAINT CLOUD, MN 56301-9668
(320) 251-8181
(320) 251-6942
Mailing address
251 COUNTY ROAD 120, SAINT CLOUD, MN 56303-4872
(320) 202-8949
(320) 202-0756
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0218261
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
886782800
—
MN
Enumeration date
06/28/2006
Last updated
11/26/2010
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