Provider Demographics
NPI:1811965155
Name:WYCKOFF, ERICH TYRONE (MD)
Entity type:Individual
Prefix:DR
First Name:ERICH
Middle Name:TYRONE
Last Name:WYCKOFF
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 1:6440 W NEWBERRY RD STE 508
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-8303
Mailing Address - Country:US
Mailing Address - Phone:352-792-6123
Mailing Address - Fax:352-792-6138
Practice Address - Street 1:6440 W NEWBERRY RD STE 508
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-8303
Practice Address - Country:US
Practice Address - Phone:352-792-6123
Practice Address - Fax:352-792-6138
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89373207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269419100Medicaid
FL37541ZMedicare PIN
FL37541YMedicare PIN
I05654Medicare UPIN
FL37541XMedicare PIN