Basic Information
| Provider Information | |||||||||
| NPI: | 1467984369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WYATT | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | CLAYTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | LANDSTUHL REGIONAL MEDICAL CENTER | ||||||||
| Address2: | UNIT 3310 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09180 | ||||||||
| CountryCode: | DE | ||||||||
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| Practice Location | |||||||||
| Address1: | LANDSTUHL REGIONAL MEDICAL CENTER | ||||||||
| Address2: | UNIT 3310 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09180 | ||||||||
| CountryCode: | DE | ||||||||
| TelephoneNumber: | 2102925077 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2017 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | OS15955 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 207RI0200X | OS15955 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.