Individual
DR. DOVILAN WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
336087473
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036126197
—
IL
01
—
P01130502
RAIL ROAD MEDICARE
IL
Enumeration date
03/30/2007
Last updated
03/08/2013
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