Individual
DOUGLAS JOHN WYLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 S PINE ST, SPARTANBURG, SC 29302-2622
(864) 515-7500
(864) 515-7501
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
28429
SC
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
28429
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284294
—
SC
01
—
P00354702
MEDICARE RAILROAD
SC
Enumeration date
06/21/2005
Last updated
11/10/2022
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