Organization
WESLEY D WYLIE MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY DOUGLAS WYLIE MD (MANAGER)
(801) 380-0432
Entity
Organization
Contact information
Practice address
280 RIVER PARK DR, PROVO, UT 84604-5764
(801) 380-0432
(801) 802-0108
Mailing address
1027 OAKRIDGE RD S, PARK CITY, UT 84098-5615
(801) 380-0432
(801) 802-0108
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
187190-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11032
—
UT
Enumeration date
05/06/2009
Last updated
05/06/2009
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