Provider Demographics
NPI:1477530830
Name:WYMORE, JAMES GUY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GUY
Last Name:WYMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 TANGLEFOOT LN
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1650
Mailing Address - Country:US
Mailing Address - Phone:563-323-2020
Mailing Address - Fax:563-328-5694
Practice Address - Street 1:2001 5TH ST
Practice Address - Street 2:SUITE 49
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-2903
Practice Address - Country:US
Practice Address - Phone:309-792-2020
Practice Address - Fax:309-792-4753
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-081788207W00000X
IA21468207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL790730OtherIL GROUP MEDICARE
IA1053918Medicaid
IA26568OtherIA GROUP MEDICARE
IA02410Medicare PIN
ILL13847Medicare PIN