Healthcare Provider Details

I. General information

NPI: 1538126008
Provider Name (Legal Business Name): ERIC R WYATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 03/31/2024
Certification Date: 03/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 WAIANUENUE ST HILO MEDICAL CENTER
HILO HI
96720
US

IV. Provider business mailing address

10800 E GEDDES AVE STE 300
ENGLEWOOD CO
80112-3895
US

V. Phone/Fax

Practice location:
  • Phone: 808-974-6841
  • Fax: 808-935-1889
Mailing address:
  • Phone: 303-761-9190
  • Fax: 808-935-5362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD12027
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD12027
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberMD12027
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD12027
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: