Individual
DR. RAYMOND B. WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 WEST 12TH STREET, UPMC REGIONAL CANCER CENTER, ERIE, PA 16505
(708) 635-9133
Mailing address
125 OAK RIDGE DR E, BURR RIDGE, IL 60527-6869
(087) 635-9133
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
036142602
IL
2085R0001X
Radiation Oncology Physician
MD438611
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118037
—
MS
05
—
009934193
—
AL
01
—
051542649
BCBS - ONE INFIRMARY CIRCLE
AL
05
—
1023982380001
—
PA
01
—
2117379
HIGHMARK
PA
05
—
276857700
—
FL
01
—
3600240
UNITED HEALTH CARE
AL
01
—
51531394
BLUE CROSS
AL
01
—
51593896
BCBS - 1660 SPRINGHILL
AL
Enumeration date
05/25/2006
Last updated
08/07/2020
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