Provider Demographics
NPI:1316956857
Name:WYMAN, RAY MICHAEL (MD)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:MICHAEL
Last Name:WYMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1360 W. SIXTH STREET
Mailing Address - Street 2:STE. 200
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3514
Mailing Address - Country:US
Mailing Address - Phone:310-547-9922
Mailing Address - Fax:310-547-4673
Practice Address - Street 1:2841 LOMITA BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5105
Practice Address - Country:US
Practice Address - Phone:310-257-0508
Practice Address - Fax:310-325-8109
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA45826207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA45826DMedicare ID - Type Unspecified
CAWA45826IMedicare ID - Type Unspecified
CAWA45826CMedicare ID - Type Unspecified
CAWA45826GMedicare ID - Type Unspecified
CAWA45826MMedicare ID - Type Unspecified
CAWA45826KMedicare ID - Type Unspecified
CAB06509Medicare UPIN