Provider Demographics
NPI:1972751915
Name:AYE, SAW WYNN (MD)
Entity Type:Individual
Prefix:
First Name:SAW
Middle Name:WYNN
Last Name:AYE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-575-6049
Mailing Address - Fax:707-782-9622
Practice Address - Street 1:104 LYNCH CREEK WAY
Practice Address - Street 2:STE 10
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2355
Practice Address - Country:US
Practice Address - Phone:707-782-9123
Practice Address - Fax:707-782-9622
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2012-02-07
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Provider Licenses
StateLicense IDTaxonomies
CAA105329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972751915Medicaid
CA0A1053290OtherBLUE SHIELD OF CALIFORNIA
CAP00680599OtherRAILROAD MEDICARE
CA1972751915Medicaid