Provider Demographics
NPI:1659327765
Name:ALGEE, WYATT ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:WYATT
Middle Name:ROBERT
Last Name:ALGEE
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 1:1067 VENDALL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1622
Mailing Address - Country:US
Mailing Address - Phone:731-285-9938
Mailing Address - Fax:731-287-8809
Practice Address - Street 1:400 E TICKLE ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3120
Practice Address - Country:US
Practice Address - Phone:731-285-9938
Practice Address - Fax:731-287-8809
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6899207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3897071Medicaid
TN3897072Medicaid
TND70177Medicare UPIN
TN3897071Medicare PIN
TN3897072Medicaid