Wynn, Brad L
Wynn, Brad L is an individual health care provider with primary practice located at 1308 8Th St Ste 1 , Rupert ID 83350-1535. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wynn, Brad L can be contacted via phone (208) 436-4322.Contact Information
Primary practice address
1308 8Th St Ste 1
Rupert ID 83350-1535
Phone: (208) 436-4322
Fax: (208) 436-1312
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | O-0676 | Idaho |
Profile Details
| NPI number | 1902033608 |
|---|---|
| LBN Legal business name | Wynn, Brad L |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 19th, 2009 |
| Last updated | Aug 25th, 2023 - about 2 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 | 1902033608 | NPPES |
| Idaho | MEDICAID | 1902033608 |
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