Organization
BOB K. WYNN, M.D. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BOB K. WYNN M.D. (OWNER)
(409) 994-2427
Entity
Organization
Contact information
Practice address
296 US HIGHWAY BUSINESS 96, BUNA, TX 77612-0437
(409) 994-2427
(409) 994-3132
Mailing address
PO BOX 1270, BUNA, TX 77612-1270
(409) 994-2427
(409) 994-3132
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F2723
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00HL63
MEDICARE
TX
05
—
112088301
—
TX
Enumeration date
12/21/2009
Last updated
12/21/2009
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