Individual
WYATT LYDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1710 HARRISON ST, BATESVILLE, AR 72501-7303
(870) 262-1200
Mailing address
PO BOX 2197, BATESVILLE, AR 72503-2197
(870) 262-5545
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
T2826
MS
207R00000X
Internal Medicine Physician
Primary
E-14622
AR
Other
Enumeration date
07/11/2014
Last updated
09/30/2021
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