Doctor Name: | DR. ROBERT ALLEN WYMER |
NPI Number: | 1730247693 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | D3448 |
Business Practice Address: | 1435 Crossways Blvd Suite 305 Chesapeake, VA - 233202896 |
Business Phone Number: | 7574247750 |
Business Fax Number: | 7574247754 |
Mailing Address: | 1200 Buddy Ct, CHESAPEAKE |
State: | VA |
Postal Code: | 233211280 |
Phone Number: | 7574881112 |
Fax Number: | |
NPI Enumeration Date: | 12/04/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | D3448 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |