Organization
DANG WYNN MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KY DAU (PHYSICIAN ASSISTANT)
(813) 960-1200
Entity
Organization
Contact information
Practice address
5332 VAN DYKE RD, LUTZ, FL 33558-4829
(813) 960-1200
Mailing address
5332 VAN DYKE RD, LUTZ, FL 33558-4829
(813) 960-1200
(813) 441-7555
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9109120
FL
Other
Enumeration date
03/28/2016
Last updated
10/17/2016
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