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General NPI Number Information
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NPI Number | 1831338391
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Entity Type | Organization
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Legal Business Name | WYATT WEBB MD PA
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Dates
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Enumeration Date | 02/06/2009
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 1001 W SOUTHLAKE BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6010
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Country | US
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Telephone | 817-310-3734
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Fax | 817-310-3767
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Provider Business Mailing Address
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Address Line | 1001 W SOUTHLAKE BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6010
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Country | US
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Telephone | 817-310-3734
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Fax | 817-310-3767
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LENORA FELAN
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Credential |
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Telephone | 817-310-3734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | L2738
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License Number State | TX
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