# TIMOTHY L WYATT MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528374741
- **Authorized official:** DR. TIMOTHY LESTER WYATT MD (PRESIDENT)
- **Authorized official phone:** (904) 981-9959

## Contact information

- **Practice address:** 2360A PARK ST, JACKSONVILLE, FL 32204-4318
- **Practice address phone:** (904) 981-9959
- **Practice address fax:** (904) 981-9956
- **Mailing address:** 2360A PARK ST, JACKSONVILLE, FL 32204-4318
- **Mailing address phone:** (904) 981-9959
- **Mailing address fax:** (904) 981-9956

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | ME64092 | FL | Yes |

## Other

- **Enumeration date:** 08/25/2010
- **Last updated:** 11/25/2025