Provider Demographics
NPI:1164483210
Name:WYANT, SCOTT (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WYANT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80217
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-0217
Mailing Address - Country:US
Mailing Address - Phone:602-385-2115
Mailing Address - Fax:480-418-3323
Practice Address - Street 1:6116 E. ARBOR AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5235
Practice Address - Country:US
Practice Address - Phone:480-924-1552
Practice Address - Fax:480-830-8417
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0427213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0194310OtherBCBS
AZ310160Medicaid
AZP00275401OtherMEDICARE RAILROAD
AZZ75815Medicare PIN
AZP00275401OtherMEDICARE RAILROAD
AZ310160Medicaid
AZAZ0194310OtherBCBS