Provider Demographics
NPI:1003874736
Name:HEMMERT, WYNN H (MD)
Entity type:Individual
Prefix:
First Name:WYNN
Middle Name:H
Last Name:HEMMERT
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 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-429-8180
Practice Address - Street 1:36 N 1100 E
Practice Address - Street 2:SUITE A
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2912
Practice Address - Country:US
Practice Address - Phone:801-772-0775
Practice Address - Fax:801-772-1941
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1620951205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0423OtherDMBA
UT107006220101OtherIHC HEALTHPLANS
UT870281028HE1OtherEMIA
UT870281028000Medicaid
UT1692OtherPEHP
UT29-00039OtherUNITED HEALTHCARE
UTQM0000009173OtherALTIUS
UT29-00039OtherUNITED HEALTHCARE