Provider Demographics
NPI:1184753014
Name:DENNIS J. WYMAN M.D.
Entity type:Organization
Organization Name:DENNIS J. WYMAN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-359-7756
Mailing Address - Street 1:175 W 200 S
Mailing Address - Street 2:SUITE 4009
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1413
Mailing Address - Country:US
Mailing Address - Phone:801-359-7756
Mailing Address - Fax:
Practice Address - Street 1:175 W 200 S
Practice Address - Street 2:SUITE 4009
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1413
Practice Address - Country:US
Practice Address - Phone:801-359-7756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1616321205208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty