Provider Demographics
NPI:1689659492
Name:WYATT, RONALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
Last Name:WYATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8371 HIGHWAY 72 W
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9505
Mailing Address - Country:US
Mailing Address - Phone:256-726-6970
Mailing Address - Fax:256-726-6971
Practice Address - Street 1:8371 HIGHWAY 72 W
Practice Address - Street 2:SUITE 104
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9505
Practice Address - Country:US
Practice Address - Phone:256-726-6970
Practice Address - Fax:256-726-6971
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME93300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16134ZMedicare ID - Type Unspecified
E38756Medicare UPIN