Individual
DR. BRAD L WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1308 8TH ST STE 1, RUPERT, ID 83350-1535
(208) 436-4322
(208) 436-1312
Mailing address
1224 8TH STREET, RUPERT, ID 83350-1527
(208) 434-4236
(208) 436-6038
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-0676
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902033608
—
ID
Enumeration date
06/19/2009
Last updated
08/25/2023
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