Provider Demographics
NPI:1184712911
Name:WYNNE, DAVID FRANK (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:FRANK
Last Name:WYNNE
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:PO BOX 380756
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35238-0756
Mailing Address - Country:US
Mailing Address - Phone:205-595-9222
Mailing Address - Fax:205-595-9444
Practice Address - Street 1:3570 GRANDVIEW PARKWAY
Practice Address - Street 2:SUITE 100-A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2033
Practice Address - Country:US
Practice Address - Phone:205-595-9222
Practice Address - Fax:205-595-9444
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515 16577OtherBLUE CROSS/BLUE SHIELD
AL7223121OtherAETNA
AL421594377OtherMEDICARE COMPLETE
AL6745381OtherCIGNA
AL7223121OtherAETNA
AL421594377OtherMEDICARE COMPLETE