Individual
RALPH WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1540 MAPLE RD, WILLIAMSVILLE, NY 14221-3647
(716) 878-7662
Mailing address
908 NIAGARA FALLS BLVD, SUITE 208, NORTH TONAWANDA, NY 14120-2019
(716) 692-3302
(716) 692-4342
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
134158
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010191701
UNIVERA
NY
01
—
000507560001
BC/BS
—
05
—
00639170
—
NY
01
—
040426000743
FIDELIS
—
01
—
3605818
IHA
—
Enumeration date
03/14/2006
Last updated
09/24/2008
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