Individual
WILLIE G. WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5720 W MEMORIAL RD, OKLAHOMA CITY, OK 73142-2010
(405) 470-7100
(405) 470-7111
Mailing address
5300 N INDEPENDENCE AVE STE 280, OKLAHOMA CITY, OK 73112-5555
(405) 552-0155
(405) 713-7690
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9068
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100116560B
—
OK
01
—
9068
LICENSE
OK
Enumeration date
07/04/2006
Last updated
10/04/2018
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