Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 21634 | TX |
NPI | 1003981721 |
---|---|
Provider Name | William M. Wyatt |
First Address | Houston, TX 77098-3900 |
Second Address | Round Rock, TX 78664-7343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |