Individual
SAMANTHA S WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
00026547
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009932289
—
AL
01
—
51001088
BCBS AL PROVIDER#
AL
05
—
529924440
—
AL
Enumeration date
05/31/2006
Last updated
12/18/2013
Update your record
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