Provider Demographics
NPI:1194086967
Name:PAUL E. WYLIE, M.D., P.A.
Entity type:Organization
Organization Name:PAUL E. WYLIE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WYLIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-661-9191
Mailing Address - Street 1:11219 FINANCIAL CENTRE PKWY
Mailing Address - Street 2:SUITE 315
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3800
Mailing Address - Country:US
Mailing Address - Phone:501-661-9191
Mailing Address - Fax:501-661-1991
Practice Address - Street 1:11219 FINANCIAL CENTRE PKWY
Practice Address - Street 2:SUITE 315
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3800
Practice Address - Country:US
Practice Address - Phone:501-661-9191
Practice Address - Fax:501-661-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN7808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE1489Medicare UPIN