Individual
PAMELA J WYMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
166 4TH STREET E, ST. PAUL, MN 55101
(651) 292-2000
(651) 292-2136
Mailing address
166 4TH STREET E, ST. PAUL, MN 55101
(651) 292-2000
(651) 292-2136
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
37571
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
089807400
—
MN
01
—
1030863
PREFERRED ONE
MN
01
—
1603279
MEDICA
MN
01
—
2182694
AMERICA'S PPO
MN
05
—
34234600
—
WI
01
—
502T0WY
BLUE CROSS
MN
01
—
502T1WY
BLUE CROSS
MN
01
—
HP43094
HEALTHPARTNERS
MN
01
—
P00201776
RAILROAD MEDICARE MN
MN
Enumeration date
06/02/2006
Last updated
07/21/2022
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