Individual
DR. WYATT MCNEILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
655 W 8TH ST, UFJP OB/GYN, JACKSONVILLE, FL 32209-6511
(904) 244-3408
(904) 244-3124
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME12384
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000875179A
—
GA
05
—
259260600
—
FL
05
—
2724073-00
—
FL
01
—
P00224904
RAILROAD MEDICARE
FL
Enumeration date
02/28/2006
Last updated
12/17/2009
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