Wesley D Wylie MD LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

187190-1205 Issued in UT

Legal business name

WESLEY D WYLIE MD LLC

Practice address

280 River Park Dr
Provo, UT 84604-5764

Phone

(801) 380-0432

Fax

(801) 802-0108

NPI assigned

May 6, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wesley Douglas Wylie, MDNPI 1548215197

Title

Manager

Phone

(801) 380-0432

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wesley D Wylie, M.D.

  • Family Medicine Physician
  • Provo, UT
  • NPI 1548215197
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1241568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241568000000",
    "number": "1437383379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 OAKRIDGE RD S",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840985615",
            "telephone_number": "801-380-0432",
            "fax_number": "801-802-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 RIVER PARK DR",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846045764",
            "telephone_number": "801-380-0432",
            "fax_number": "801-802-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESLEY D WYLIE MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-06",
        "last_updated": "2009-05-06",
        "status": "A",
        "authorized_official_last_name": "WYLIE",
        "authorized_official_first_name": "WESLEY",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "801-380-0432",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "UT",
            "license": "187190-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11032",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla Wendelboe
• Mark Wendelboe
• Carrie Lynn Elizabeth Wendt
• Douglas Michael Wendt, LCSW, PHD
• Becky Bytheway Wengreen, LMFT
• West 1020 Healthcare, Inc.
• Michael West, ATC
• Samantha Joan West
• Susanna Bean West, CRNA
• Deborah Eileen Westmoreland, M.S.

• Primary Care Clinic/Center in Provo, UT
• Providers in Provo, UT by specialty
• Primary Care Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.