Individual
DR. DANIEL S WYZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
425 NORTH LEE ST, SUITE 203, JACKSONVILLE, FL 32204-1128
(904) 354-8200
(904) 354-1340
Mailing address
425 NORTH LEE ST, SUITE 203, JACKSONVILLE, FL 32204-1128
(904) 354-8200
(904) 354-1340
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
ME48699
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00453747A
MEDICAID OF GEORGIA
GA
05
—
051258300
—
FL
01
—
07238Z
BCBS OF FLORIDA
FL
01
—
2540584
AETNA
FL
Enumeration date
07/14/2006
Last updated
05/28/2014
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