Individual
GREGORY PEARSON WYNNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
9669 E 146TH ST STE 330, NOBLESVILLE, IN 46060-5006
(317) 355-2663
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-1647
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
02006722A
IN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
02006722A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
266180L93
MEDICARE
—
05
—
300065787
—
IN
01
—
Q00387672
RAILROAD MEDICARE
IN
Enumeration date
04/11/2016
Last updated
06/13/2023
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