Provider Demographics
NPI:1801808043
Name:WYNNE, HOWARD E (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:E
Last Name:WYNNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2001 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2303
Mailing Address - Country:US
Mailing Address - Phone:619-446-1530
Mailing Address - Fax:
Practice Address - Street 1:3555 KENYON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5341
Practice Address - Country:US
Practice Address - Phone:619-221-9558
Practice Address - Fax:619-221-9592
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54852174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHM226ZMedicare Oscar/Certification
CAG49074Medicare UPIN