Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 23942 | MN |
NPI | 1235117177 |
---|---|
Provider Name | Richard A Wyatt |
First Address | Minneapolis, MN 55416-2527 |
Second Address | St Louis Park, MN 55416-2527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2006 |
Last Update Date | 08/03/2012 |