Provider Demographics
NPI:1770760076
Name:WYMAN, STEPHEN MARC (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARC
Last Name:WYMAN
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 1:17011 BEACH BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5998
Mailing Address - Country:US
Mailing Address - Phone:714-842-8680
Mailing Address - Fax:
Practice Address - Street 1:17011 BEACH BLVD STE 900
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5998
Practice Address - Country:US
Practice Address - Phone:714-842-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA225292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22529OtherSTATE LICENSE
AW0000719OtherDEA