Provider Demographics
NPI:1114003480
Name:WYLIE, PAUL E (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:WYLIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11219 FINANCIAL CENTRE PKWY
Mailing Address - Street 2:FINANCIAL PARK PLACE, SUITE 315
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3800
Mailing Address - Country:US
Mailing Address - Phone:501-661-9299
Mailing Address - Fax:501-661-1991
Practice Address - Street 1:11219 FINANCIAL CENTRE PKWY
Practice Address - Street 2:FINANCIAL PARK PLACE, SUITE 315
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3800
Practice Address - Country:US
Practice Address - Phone:501-661-9299
Practice Address - Fax:501-661-1991
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-78082084S0012X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116682001Medicaid
AR4250575OtherAETNA PROVIDER #
AR492001OtherUNITEDHEALTHCARE PROV #
AR9732951002OtherCIGNA PROVIDER #
AR260036509OtherRAILROAD MEDICARE PROV #
AR9732951002OtherCIGNA PROVIDER #
AR260036509OtherRAILROAD MEDICARE PROV #