Provider Demographics
NPI:1508673989
Name:WYNNE, BRIAN RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RICHARD
Last Name:WYNNE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11340 BARTHOLOMEW RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-9089
Mailing Address - Country:US
Mailing Address - Phone:215-275-7630
Mailing Address - Fax:440-543-9521
Practice Address - Street 1:11340 BARTHOLOMEW RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-9089
Practice Address - Country:US
Practice Address - Phone:215-275-7630
Practice Address - Fax:440-543-9521
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD062475L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease