Healthcare Provider Details

I. General information

NPI: 1467984369
Provider Name (Legal Business Name): ANDREW WYATT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 3310
APO AE
09180
DE

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 3310
APO AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 210-292-5077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number109927
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberOS15955
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS15955
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number109927
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: