Individual
DR. BILLY DEMETRIUS WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 CURVE CREST BLVD W, STILLWATER, MN 55082-6040
(651) 439-1234
(651) 439-1547
Mailing address
1500 CURVE CREST BLVD W, STILLWATER, MN 55082-6040
(651) 439-1234
(651) 439-1547
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
46154
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34596300
—
WI
05
—
766109600
—
MN
Enumeration date
11/29/2005
Last updated
02/15/2011
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