Individual
E. M. BRENDAN WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2 OFFICE PARK CIR, SELMA, AL 36701-6538
(334) 872-3403
(334) 872-3405
Mailing address
2 OFFICE PARK CIR, SELMA, AL 36701-6538
(334) 872-3403
(334) 872-3405
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
20641
AL
207W00000X
Ophthalmology Physician
ME167191
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000002044
—
AL
05
—
009976795
—
AL
01
—
051002044
BLUE CROSS BLUE SHIELD
AL
01
—
051525773
BLUE CROSS BLUE SHIELD
AL
Enumeration date
07/27/2006
Last updated
08/22/2024
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