Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 8135 | SC |
N | 213EG0000X | General Practice | 8135 | SC |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 8135 | SC |
NPI | 1093062861 |
---|---|
Provider Name | Dr. Joshua Glenn Hyatt |
First Address | Fort Wainwright, AK 99703 |
Second Address | Fort Wainwright, AK 99703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2012 |
Last Update Date | 28/08/2017 |