Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. DEREK R WYNN, PA
Active Sole ProprietorMR. DEREK R WYNN, PA is a Medical Physician Assistant healthcare provider located in GRANGEVILLE, Idaho. NPI 1043689441 is currently active in the NPPES registry. Verify at CMS.
Medical Physician Assistant · GRANGEVILLE, ID
Registration Details
- NPI Number
- 1043689441
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Sep 16, 2015 (10.871578120745 yrs)
- Last Updated
- Sep 16, 2015
- License
-
PA-1276 (ID)
- Sole Proprietor
- Yes
Practice Information
- Address
-
607 W MAIN STREETGRANGEVILLE, ID, 83530Browse ID providers · Browse ZIP 83530
- Phone
- 2089831700
- Fax
- 2089834665
- Primary Specialty
-
Medical Physician Assistant
363AM0700X
Other Medical Physician Assistant Providers in GRANGEVILLE, ID
| Name | Credential | NPI |
|---|---|---|
| MATTHEW WADE BLACK | PA | 1891415063 |
| BRADI MOREL VOIGT TRAPP | PA-C | 1538046339 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.