MEDICARE: DR. ROBBY W 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	2084P0800X	Psychiatry Physician	10642	MT
2	2084P0800X	Psychiatry Physician	35.093323	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10642	OTHER	MT	STATE LICENSE NUMBER
2	35.093323	OTHER	OH	MEDICAL LICENSE

General Provider Information

NPI Number	:	1982693867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBBY W WYATT M.D.

Provider Business Mailing Address
First Line	:	90 HOSPITAL DR
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-2301
Country	:	US
Telephone Number	:	740-592-3091
Fax Number	:	740-775-7855

Provider Business Practice Location Address
First Line	:	90 HOSPITAL DR
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-2301
Country	:	US
Telephone Number	:	740-592-3091
Fax Number	:	740-593-8659

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	03/07/2023

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