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General NPI Number Information
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NPI Number | 1649487430
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Entity Type | Individual
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Provider Name | CHRISTOPHER C WYATT MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 1055 N CURTIS ROAD S6
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City | BOISE
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State | ID
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Zip | 83706
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Country | US
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Telephone | 208-302-0800
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Fax | 208-302-0855
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Provider Business Mailing Address
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Address Line | 3340 E GOLDSTONE WAY
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-302-0800
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Fax | 208-302-0855
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M-10687
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | R-7842
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD183860
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | M-10687
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License Number State | ID
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