Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | DP0780 | TX |
N | 222Z00000X | Podiatrist | DP0780 | TX |
Y | 213ES0103X | Foot & Ankle Surgery | DP0780 | TX |
NPI | 1013919471 |
---|---|
Provider Name | Michael Hanlon Wynn |
First Address | Kingwood, TX 77339-1535 |
Second Address | Kingwood, TX 77339-1535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112230102 | (05) | TX |
T16763 | (02) |