Angela Wyatt Dermatology, P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

42581 Issued in AZ

Legal business name

ANGELA WYATT DERMATOLOGY, P.C.

Practice address

150 N Verde St
Suite 101
Flagstaff, AZ 86001-5256

Phone

(928) 779-6923

Fax

(928) 779-6924

NPI assigned

Dec 18, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Angela Wyatt, M.D.

Title

President

Phone

(928) 779-6923

Specialties & licenses 5

Addresses

Other identifiers 1

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2335/brand/1/csg/1/fhir/r4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547510400000",
    "number": "1053640151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 N VERDE ST",
            "address_2": "SUITE 101",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860015256",
            "telephone_number": "928-779-6923",
            "fax_number": "928-779-6924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 N VERDE ST",
            "address_2": "SUITE 101",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860015256",
            "telephone_number": "928-779-6923",
            "fax_number": "928-779-6924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELA WYATT DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-18",
        "last_updated": "2019-01-15",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-779-6923",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "42581",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "AZ",
            "license": "42581",
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "AZ",
            "license": "42581",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "AZ",
            "license": "42581",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AZ",
            "license": "42581",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1528011368",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.