Provider Demographics
NPI:1942341573
Name:WYNN, DONNY (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNY
Middle Name:
Last Name:WYNN
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 1:1111 N LEE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2600
Mailing Address - Country:US
Mailing Address - Phone:405-231-8740
Mailing Address - Fax:405-231-8714
Practice Address - Street 1:1111 N LEE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2600
Practice Address - Country:US
Practice Address - Phone:405-231-8740
Practice Address - Fax:405-231-8714
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25119207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism