Wylie, Jack Winfred
Wylie, Jack Winfred is an individual health care provider with primary practice located at 450 S Willard St Suite 105, Cottonwood AZ 86326-6743. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Wylie, Jack Winfred can be contacted via phone (928) 634-1112.Contact Information
Primary practice address
450 S Willard St Suite 105
Cottonwood AZ 86326-6743
Phone: (928) 634-1112
Fax: (928) 634-1117
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 23100 | Arizona |
Profile Details
| NPI number | 1043255052 |
|---|---|
| LBN Legal business name | Wylie, Jack Winfred |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 17th, 2006 |
| Last updated | Mar 16th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043255052 | NPPES |
| Arizona | MEDICAID | 212134 |
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