Wyatt, Brent Michael

Wyatt, Brent Michael is an sole proprietor health care provider with primary practice located at 910 S Kimball Ave , Southlake TX 76092-9005. He recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Adult Mental Health, Allopathic & Osteopathic Physicians / Emergency Medical Services. Allopathic & Osteopathic Physicians / Emergency Medical Services is his primary health care specialty. Wyatt, Brent Michael can be contacted via phone (817) 527-3470.

Contact Information

Primary practice address
910 S Kimball Ave Southlake TX 76092-9005
Phone: (817) 527-3470
Fax: (817) 527-3444
Website:
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Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Adult Mental Health 261QM0850X
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X M7769 Texas

Profile Details

NPI number 1346283025
LBN Legal business name Wyatt, Brent Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 13th, 2006
Last updated Mar 5th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346283025 NPPES
Texas MEDICAID 189948601
Texas Other 8AH272
Texas MEDICAID 189948603

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