Provider Demographics
NPI:1598909889
Name:WYMAN, ALLISON M (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:WYMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2410 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2236
Mailing Address - Country:US
Mailing Address - Phone:727-499-0351
Mailing Address - Fax:727-781-3312
Practice Address - Street 1:2919 W SWANN AVE STE 404
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4052
Practice Address - Country:US
Practice Address - Phone:813-773-0579
Practice Address - Fax:941-253-3401
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2024-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME115925207VF0040X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLXBO63OtherBLUE CROSS BLUE SHIELD
FL017766300Medicaid
FL017766300Medicaid