Individual
JOHN W WY
Active
Individual
JOHN W WY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01064117A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000532443
ANTHEM PIN
—
01
—
100180890G
MEDICAID GROUP
IN
05
—
200873000
—
IN
01
—
50022487
PASSPORT
KY
05
—
7100018670
—
KY
01
—
P00418326
RAIL ROAD MEDICARE
—
Enumeration date
07/20/2006
Last updated
05/18/2022
Update your record
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