Wyatt, P Wade

Wyatt, P Wade is an individual health care provider with primary practice located at 4878 Highland Dr , Holladay UT 84117-6007. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Wyatt, P Wade can be contacted via phone (801) 272-8861.

Contact Information

Primary practice address
4878 Highland Dr Holladay UT 84117-6007
Phone: (801) 272-8861
Fax: (801) 272-8867
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 64451081205 Utah

Profile Details

NPI number 1700082104
LBN Legal business name Wyatt, P Wade
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2007
Last updated Sep 30th, 2009 - about 16 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 1700082104 NPPES
Utah MEDICAID 1700082104

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