MEDICARE: CHRISTOPHER WYATT, M.D. PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1598231086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER WYATT, M.D. PLLC

Provider Business Mailing Address
First Line	:	801 SUGARBUSH LN
Second Line	:
City	:	BURKBURNETT
State	:	TX
Zip	:	76354-2538
Country	:	US
Telephone Number	:	833-379-9288
Fax Number	:	405-253-0577

Provider Business Practice Location Address
First Line	:	312 S AVENUE D
Second Line	:
City	:	BURKBURNETT
State	:	TX
Zip	:	76354-3564
Country	:	US
Telephone Number	:	833-379-9288
Fax Number	:	405-253-0577

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. CHRISTOPHER WYATT
Credential	:	MD
Telephone Number	:	833-379-9288

Provider Enumeration Date	:	10/23/2018
Last Update Date	:	10/29/2018

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