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Individual

ROBERT J WYLIE

Active
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Individual

ROBERT J WYLIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

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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