Wyatt, John Creedmore
Wyatt, John Creedmore is an individual health care provider with primary practice located at 529 N Galloway Ave Suite 16, Mesquite TX 75149-3420. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Wyatt, John Creedmore can be contacted via phone (972) 216-4411.Contact Information
Primary practice address
529 N Galloway Ave Suite 16
Mesquite TX 75149-3420
Phone: (972) 216-4411
Fax: (972) 216-7346
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | E6695 | Texas |
Profile Details
| NPI number | 1871584904 |
|---|---|
| LBN Legal business name | Wyatt, John Creedmore |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 28th, 2005 |
| Last updated | Sep 22nd, 2008 - about 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871584904 | NPPES |
| Texas | Other | 88R743 | BCBS |
| Texas | MEDICAID | 117996202 | BCBS |
| Texas | Other | B005 | BCBS |
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