Individual
DR. JONATHAN DAVID WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 FAIR PARK BLVD, LITTLE ROCK, AR 72204
(501) 604-6900
Mailing address
800 FAIR PARK BLVD, LITTLE ROCK, AR 72204-1720
(501) 978-2623
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
E-7431
AR
207X00000X
Orthopaedic Surgery Physician
RS2011-0385
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192471001
—
AR
Enumeration date
07/26/2007
Last updated
05/19/2021
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