Individual
P WADE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4878 HIGHLAND DR, HOLLADAY, UT 84117-6007
(801) 272-8861
(801) 272-8867
Mailing address
1901 W PARKWAY BLVD, SALT LAKE CITY, UT 84119
(801) 886-2020
(801) 954-0054
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
64451081205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700082104
—
UT
Enumeration date
06/22/2007
Last updated
09/30/2009
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