Individual
MARK W WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6301 HARRIS PKWY STE 200, FORT WORTH, TX 76132-4249
(817) 433-3450
(817) 294-6429
Mailing address
6301 HARRIS PKWY STE 200, FORT WORTH, TX 76132-4249
(817) 433-3450
(817) 294-6429
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
L7265
TX
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
L7265
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161222802
—
TX
01
—
P00166250
RAIL ROAD MEDICARE
—
Enumeration date
07/13/2006
Last updated
09/25/2019
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