Provider Demographics
NPI:1912026782
Name:WYATT, KAREN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:WYATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5070
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-5070
Mailing Address - Country:US
Mailing Address - Phone:970-468-9186
Mailing Address - Fax:970-468-9260
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-4337
Practice Address - Country:US
Practice Address - Phone:970-668-4040
Practice Address - Fax:970-668-6699
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO38129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D87605Medicare UPIN