Individual
DONRAPHAEL WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1072 N LIBERTY ST, STE 303, BOISE, ID 83704
(208) 302-4200
(208) 302-4255
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642
(208) 302-4200
(208) 302-4255
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
9164199-1205
UT
207WX0109X
Neuro-ophthalmology Physician
9164199-1205
UT
2084N0400X
Neurology Physician
Primary
M-14403
ID
Other
Enumeration date
04/16/2013
Last updated
11/13/2025
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