Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 4623 | TX |
Y | 213ER0200X | Radiology | 4623 | TX |
NPI | 1073561734 |
---|---|
Provider Name | Dr. Lawrence Henry Wyatt JR. |
First Address | Houston, TX 77062-2013 |
Second Address | Pasadena, TX 77505-1602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |