Provider Demographics
NPI:1629206925
Name:WYBOURN, CHRISTOPHER ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ANTHONY
Last Name:WYBOURN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7930 FROST ST
Mailing Address - Street 2:STE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2739
Mailing Address - Country:US
Mailing Address - Phone:858-565-0104
Mailing Address - Fax:858-565-0194
Practice Address - Street 1:7930 FROST ST
Practice Address - Street 2:STE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2739
Practice Address - Country:US
Practice Address - Phone:858-565-0104
Practice Address - Fax:858-565-0194
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2020-11-25
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Provider Licenses
StateLicense IDTaxonomies
CAA130416208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery