Provider Demographics
NPI:1558811232
Name:WYMER, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WYMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11438 CAYE FALLS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-4102
Mailing Address - Country:US
Mailing Address - Phone:266-426-9077
Mailing Address - Fax:
Practice Address - Street 1:5115 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-2932
Practice Address - Country:US
Practice Address - Phone:850-378-8773
Practice Address - Fax:850-378-8778
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109856363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant