Provider Demographics
NPI:1568642361
Name:WYATT, JAMISON N (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMISON
Middle Name:N
Last Name:WYATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 OXFORD DR STE 104
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7423
Mailing Address - Country:US
Mailing Address - Phone:830-214-0300
Mailing Address - Fax:830-214-0397
Practice Address - Street 1:479 OXFORD DR STE 104
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5479
Practice Address - Country:US
Practice Address - Phone:830-214-0300
Practice Address - Fax:830-214-0397
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9752207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM9752OtherMEDICAL LICENSE
TX196568302Medicaid
TX196568301Medicaid
TX196568301Medicaid
TX8L2151Medicare PIN