MEDICARE: DAVID J WYATT M.D.

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	207Q00000X	Family Medicine Physician	42979	GA
2	207Q00000X	Family Medicine Physician	125960	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619967452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID J WYATT M.D.

Provider Business Mailing Address
First Line	:	68 SE 6TH ST APT 2804
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3493
Country	:	US
Telephone Number	:	404-895-1536
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 SE 6TH ST APT 2804
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131
Country	:	US
Telephone Number	:	404-895-1536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/18/2018

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