Organization
LEWIS WYATT JR. M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEWIS WYATT JR. MD (PRESIDENT)
(310) 360-7430
Entity
Organization
Contact information
Practice address
99 N LA CIENEGA BLVD, BEVERLY HILLS, CA 90211-2222
(310) 360-7430
(310) 360-7430
Mailing address
2061 WESTRIDGE RD, LOS ANGELES, CA 90049-1805
(310) 360-7430
(310) 360-7435
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
00C320300
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14078963127
—
CA
01
—
FS794A
PTAN
CA
05
—
FSW794A
—
CA
Enumeration date
12/22/2017
Last updated
06/16/2018
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