Organization
ROBERT J WYLIE MD PC
Active
Organization
ROBERT J WYLIE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT J WYLIE MD (OWNER)
(928) 242-1162
Entity
Organization
Contact information
Practice address
5078 HIGH DR, LAKESIDE, AZ 85929-5551
(928) 242-1162
(928) 368-9080
Mailing address
PO BOX 2170, LAKESIDE, AZ 85929-2170
(928) 242-1162
(928) 368-9080
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
18644A
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
241333500
OWCP
—
05
—
286254
—
AZ
01
—
AZ0342850
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
02/14/2006
Last updated
03/21/2012
Update your record
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