Individual
WINDY A WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
50 MARQUIS RD, FREEPORT, ME 04032-6477
(207) 865-6131
(207) 865-9399
Mailing address
50 MARQUIS RD, FREEPORT, ME 04032-6477
(207) 865-6131
(207) 865-9399
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO2838
ME
207R00000X
Internal Medicine Physician
Q2088
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356637805
—
ME
05
—
345061101
—
TX
05
—
345061102
—
TX
01
—
379203YLP1
MEDICARE PTAN
TX
01
—
379203YLP2
MEDICARE PTAN
TX
Enumeration date
06/23/2011
Last updated
04/10/2019
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