Individual
MICHAEL L WYNN I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1655 LIBERTY ST SE, SALEM, OR 97302-4347
(503) 581-7959
(503) 362-4114
Mailing address
1655 LIBERTY ST SE, SALEM, OR 97302-4347
(503) 581-7959
(503) 362-4114
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
DO15695
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203505
—
OR
Enumeration date
05/15/2006
Last updated
06/21/2016
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