Individual
DR. JOHN WAGNER TYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14300 ORCHARD PKWY FL 3, WESTMINSTER, CO 80023
(303) 426-2580
(303) 426-2590
Mailing address
PO BOX 911057, DENVER, CO 80291-1057
(888) 269-7001
(303) 764-6640
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
A00067848
CA
207V00000X
Obstetrics & Gynecology Physician
Primary
DR.0053014
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A678480
—
CA
01
—
160055143
RAILROAD MEDICARE
—
01
—
268688
OMAP MEDICAID
OR
01
—
R112329
NORIDIAN MEDICARE
OR
01
—
ZZZ09988Z
BLUE SHIELD
CA
Enumeration date
06/09/2006
Last updated
06/06/2018
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