Provider Demographics
NPI:1700226602
Name:WYNN, CAMERON HEWLETT (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:HEWLETT
Last Name:WYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 MED PARK STE 350
Mailing Address - Street 2:EMERGENCY MEDICINE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-3790
Mailing Address - Fax:803-434-3946
Practice Address - Street 1:14 MED PARK STE 350
Practice Address - Street 2:EMERGENCY MEDICINE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-3790
Practice Address - Fax:803-434-3946
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA308447207P00000X
SCLL35954207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine