Individual
DR. KIMBERLY SUE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
509 SE RIVERSIDE DR STE 303, STUART, FL 34994-2579
(772) 283-9111
(772) 781-2785
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-2832
(772) 223-5665
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME121614
FL
207RG0100X
Gastroenterology Physician
Primary
ME121614
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016279500
—
FL
01
—
IBWUZ
FLORIDA BLUE
FL
Enumeration date
12/15/2005
Last updated
10/13/2020
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