Organization
ANGELA WYATT DERMATOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA WYATT M.D. (PRESIDENT)
(928) 779-6923
Entity
Organization
Contact information
Practice address
150 N VERDE ST, SUITE 101, FLAGSTAFF, AZ 86001-5256
(928) 779-6923
(928) 779-6924
Mailing address
150 N VERDE ST, SUITE 101, FLAGSTAFF, AZ 86001-5256
(928) 779-6923
(928) 779-6924
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
42581
AZ
207ND0900X
Dermatopathology Physician
42581
AZ
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
42581
AZ
207NP0225X
Pediatric Dermatology Physician
42581
AZ
207NS0135X
Procedural Dermatology Physician
42581
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528011368
NPI
—
Enumeration date
12/18/2009
Last updated
01/15/2019
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