Provider Demographics
NPI:1851659858
Name:WYNKOOP, AARON THOMAS
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:THOMAS
Last Name:WYNKOOP
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 1:4465 RISKE DRVIE
Mailing Address - Street 2:APT1
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4765
Practice Address - Country:US
Practice Address - Phone:843-383-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC82439207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program