Provider Demographics
NPI:1093798027
Name:WYSE, GENE LAMAR (DO)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:LAMAR
Last Name:WYSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-4425
Mailing Address - Country:US
Mailing Address - Phone:308-236-7016
Mailing Address - Fax:308-236-7027
Practice Address - Street 1:2605 2ND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4425
Practice Address - Country:US
Practice Address - Phone:308-236-7016
Practice Address - Fax:308-236-7027
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B91199Medicare UPIN
NE274500Medicare ID - Type Unspecified