Provider Demographics
NPI:1225598220
Name:WYKOFF, GREGORY EMERSON (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:EMERSON
Last Name:WYKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 E CHESTNUT ST UNIT 610
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5711
Mailing Address - Country:US
Mailing Address - Phone:502-588-4865
Mailing Address - Fax:502-588-4427
Practice Address - Street 1:1890 N REVERE CT # F546
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7464
Practice Address - Country:US
Practice Address - Phone:303-724-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.00688642084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry