| Wesley D Wylie Md Llc | |
|
280 River Park Dr Provo UT 84604-5764 | |
| (801) 380-0432 | |
| (801) 802-0108 |
| Full Name | Wesley D Wylie Md Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 280 River Park Dr, Provo, Utah |
| Authorized Official Name and Position | Wesley Douglas Wylie (MANAGER) |
| Authorized Official Contact | 8013800432 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wesley D Wylie Md Llc 1027 Oakridge Rd S Park City UT 84098-5615 Ph: (801) 380-0432 | Wesley D Wylie Md Llc 280 River Park Dr Provo UT 84604-5764 Ph: (801) 380-0432 |
| NPI Number | 1437383379 |
|---|---|
| Provider Enumeration Date | 05/06/2009 |
| Last Update Date | 05/06/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437383379 | NPI | - | NPPES |
| 11032 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 187190-1205 (Utah) | Primary |
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