DEREK R WYNN

GRANGEVILLE, ID
NPI1043689441
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: ID  PA-1276)
Enumeration Date2015-09-16
Last Update Date2015-09-16
Business Address
Mr. DEREK R WYNN PA
607 W MAIN STREET
GRANGEVILLE, ID 83530
Phone number: 208-983-1700
Mailing Address
Mr. DEREK R WYNN PA
607 W MAIN ST
GRANGEVILLE, ID 83530-1345
Phone number: 208-983-1700
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