1184839821 NPI number — DR. WYNN W. CALL

Table of content: DR. WYNN W. CALL (NPI 1184839821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184839821 NPI number — DR. WYNN W. CALL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALL
Provider First Name:
WYNN
Provider Middle Name:
W.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALL, PH.D
Provider Other First Name:
WYNN
Provider Other Middle Name:
W.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184839821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 N COUNTRY CLUB DR
Provider Second Line Business Mailing Address:
SUITE # 10
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85201-2537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-836-8883
Provider Business Mailing Address Fax Number:
480-962-4308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 N COUNTRY CLUB DR
Provider Second Line Business Practice Location Address:
SUITE # 10
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85201-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-836-8883
Provider Business Practice Location Address Fax Number:
480-962-4308
Provider Enumeration Date:
05/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LPC 1434 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)