Individual
MR. LANCE EVERETT WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8631 W 3RD ST, STE. 1130 EAST TOWER, LOS ANGELES, CA 90048-5901
(310) 855-8010
(310) 855-8015
Mailing address
8631 W 3RD ST, STE. 1130 EAST TOWER, LOS ANGELES, CA 90048-5901
(310) 855-8010
(310) 855-8015
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
G79180
CA
Other
Enumeration date
08/29/2006
Last updated
07/08/2007
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