Individual
CHARLES BRADFORD WYSONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 S CENTRAL EXPY, WEST PARK MEDICAL CENTER, MCKINNEY, TX 75070-3742
(972) 548-5308
(972) 548-5433
Mailing address
PO BOX 740968, DALLAS, TX 75374-0968
(800) 945-2455
(903) 453-2541
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
E1192
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126284203
—
TX
Enumeration date
04/17/2006
Last updated
07/30/2009
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