Healthcare Provider Details

I. General information

NPI: 1417261835
Provider Name (Legal Business Name): WILLIAM J. WYATT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 DELL RANGE BLVD SUITE 206
CHEYENNE WY
82009-4941
US

IV. Provider business mailing address

2232 DELL RANGE BLVD SUITE 206
CHEYENNE WY
82009-4941
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-8987
  • Fax: 307-638-7829
Mailing address:
  • Phone: 307-638-8987
  • Fax: 307-638-7829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM J WYATT
Title or Position: PHYSCIAN
Credential: MD
Phone: 307-638-8987