Individual
ROBERT J WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 WEST HOSPITAL DRIVE, WHITERIVER, AZ 85941-0860
(928) 338-4911
(928) 338-5508
Mailing address
PO BOX 860, WHITERIVER, AZ 85941-0860
(928) 338-4911
(928) 338-5508
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
18644A
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295993376
—
AZ
05
—
1629236716
—
AZ
05
—
1780614008
—
AZ
05
—
1871523191
—
AZ
01
—
241333500
OWCP
—
05
—
286254
—
AZ
01
—
AZ0342850
BLUE CROSS BLUE SHIELD AZ
AZ
Enumeration date
02/14/2006
Last updated
01/15/2021
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