Provider Demographics
NPI:1538126008
Name:WYATT, ERIC R (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:R
Last Name:WYATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:808-935-5362
Practice Address - Street 1:1190 WAIANUENUE ST
Practice Address - Street 2:HILO MEDICAL CENTER
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-974-6841
Practice Address - Fax:808-935-1889
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD120272085N0904X, 2085R0204X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51719601Medicaid
HI54826Medicare ID - Type Unspecified
H70069Medicare UPIN