MEDICARE: ANDREW WYATT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	109927	GA
2	207RI0200X	Infectious Disease Physician	OS15955	FL
3	208D00000X	General Practice Physician	OS15955	FL
4	208M00000X	Hospitalist Physician	109927	GA

General Provider Information

NPI Number	:	1467984369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW WYATT

Provider Business Mailing Address
First Line	:	LANDSTUHL REGIONAL MEDICAL CENTER
Second Line	:	UNIT 3310
City	:	APO
State	:	AE
Zip	:	09180
Country	:	DE
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	LANDSTUHL REGIONAL MEDICAL CENTER
Second Line	:	UNIT 3310
City	:	APO
State	:	AE
Zip	:	09180
Country	:	DE
Telephone Number	:	210-292-5077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	05/27/2026

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