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Individual

DAVID J WYATT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4845 MAIN STREET, SUITE B-1, ZACHARY, LA 70791-5364
(225) 658-9996
(225) 658-9970
Mailing address
PO BOX 975, ZACHARY, LA 70791-0975
(225) 658-9996
(225) 658-9970

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
15788R
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1473472
LA
Enumeration date
04/18/2006
Last updated
10/13/2011
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