Individual
ROGER WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
315 E ELM ST, STE 100, CALDWELL, ID 83605
(208) 302-7100
(208) 302-7155
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-7100
(208) 302-7155
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-12951
ID
207Q00000X
Family Medicine Physician
R73187
AZ
Other
Enumeration date
04/18/2012
Last updated
12/05/2016
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