Provider Demographics
NPI:1508216268
Name:WYNN, DARCY DUBUC (MD)
Entity type:Individual
Prefix:DR
First Name:DARCY
Middle Name:DUBUC
Last Name:WYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:
Other - Last Name:DUBUC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:815 SW BOND ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3593
Mailing Address - Country:US
Mailing Address - Phone:541-382-2811
Mailing Address - Fax:
Practice Address - Street 1:815 SW BOND ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3593
Practice Address - Country:US
Practice Address - Phone:541-382-2811
Practice Address - Fax:541-706-6443
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61369459207Q00000X
VA0101263273207Q00000X
OR214736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN