Individual
DOUGLAS B WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3501 S SONCY RD STE 109, AMARILLO, TX 79119-6405
(806) 467-2888
(806) 467-2999
Mailing address
3501 S SONCY RD STE 109, AMARILLO, TX 79119-6405
(806) 467-2888
(806) 467-2999
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G9018
TX
2086S0129X
Vascular Surgery Physician
G9018
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00N46H
BCBS OF TEXAS
TX
05
—
035017501
—
TX
Enumeration date
08/14/2006
Last updated
05/31/2011
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