Provider Demographics
NPI:1356048193
Name:SMITH, WYATT ALEXANDER RIVAS (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:WYATT
Middle Name:ALEXANDER RIVAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:BROOKE ARMY MEDICAL CENTER, MCHE-ZSO DEPT ORTHOPAEDICS
Mailing Address - Street 2:3551 ROGER BROOKE DR
Mailing Address - City:JBSA-FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-916-1284
Mailing Address - Fax:
Practice Address - Street 1:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-ZSO ORTHOPAED
Practice Address - Street 2:3551 ROGER BROOKE DR
Practice Address - City:JBSA-FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X, 390200000X
VA0101284849208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program