Provider Demographics
NPI:1881899417
Name:WYLIE, ZEPHYRINUS GABRIEL (DO)
Entity type:Individual
Prefix:DR
First Name:ZEPHYRINUS
Middle Name:GABRIEL
Last Name:WYLIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ZEPH
Other - Middle Name:G
Other - Last Name:WYLIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-0343
Mailing Address - Country:US
Mailing Address - Phone:509-956-9799
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:320 BEARD CREEK RD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-6426
Practice Address - Country:US
Practice Address - Phone:509-956-9799
Practice Address - Fax:817-877-0350
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0060922207L00000X
WAOP60616769207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology