MEDICARE: DARREL W WYATT MD

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	207V00000X	Obstetrics & Gynecology Physician	034830	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	:	1639282775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREL W WYATT MD

Provider Business Mailing Address
First Line	:	700 ZEAGLER DR
Second Line	:	SUITE 9
City	:	PALATKA
State	:	FL
Zip	:	32177-6806
Country	:	US
Telephone Number	:	386-326-1629
Fax Number	:	386-325-8611

Provider Business Practice Location Address
First Line	:	700 ZEAGLER DR.
Second Line	:	SUITE 9
City	:	PALATKA
State	:	FL
Zip	:	32177-6806
Country	:	US
Telephone Number	:	386-326-1629
Fax Number	:	386-325-8611

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	10/28/2011

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Directions to “ DARREL W WYATT MD” Practice Location

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