MEDICARE: NORTH DALLAS OTOLARYNGOLOGY CONSULTANTS

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	235Z00000X	Speech-Language Pathologist	18470	TX
2	231H00000X	Audiologist	51752	TX
3	174400000X	Specialist	J8423	TX
4	174400000X	Specialist	L5957	TX
5	174400000X	Specialist	N2729	TX
6	174400000X	Specialist	P3282	TX

General Provider Information

NPI Number	:	1952558991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH DALLAS OTOLARYNGOLOGY CONSULTANTS

Provider Business Mailing Address
First Line	:	11970 N CENTRAL EXPY
Second Line	:	SUITE 400
City	:	DALLAS
State	:	TX
Zip	:	75243-3768
Country	:	US
Telephone Number	:	214-382-5100
Fax Number	:	214-382-5199

Provider Business Practice Location Address
First Line	:	11970 N CENTRAL EXPY
Second Line	:	SUITE 400
City	:	DALLAS
State	:	TX
Zip	:	75243-3768
Country	:	US
Telephone Number	:	214-382-5100
Fax Number	:	214-382-5199

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH ROBERT WYATT
Credential	:	M.D.
Telephone Number	:	214-382-5100

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	11/28/2016

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Directions to “NORTH DALLAS OTOLARYNGOLOGY CONSULTANTS ” Practice Location

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