John Creedmore Wyatt III, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

E6695 Issued in TX

Practice address

529 N Galloway Ave
Suite 16
Mesquite, TX 75149-3420

Phone

(972) 216-4411

Fax

(972) 216-7346

NPI assigned

Oct 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222041600000",
    "number": "1871584904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 180065",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752180065",
            "telephone_number": "972-216-4411",
            "fax_number": "972-216-7346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 N GALLOWAY AVE",
            "address_2": "SUITE 16",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751493420",
            "telephone_number": "972-216-4411",
            "fax_number": "972-216-7346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "JOHN",
        "middle_name": "CREEDMORE",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2008-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "E6695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "88R743",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117996202",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "B005",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brynn Elaine Wreford, DPT
• Guanita Wright
• Paul H. Wright, MD
• Rebecca Wright, PH.D.
• Tashayla Wright
• XI Wave Clinic
• Yahweh Home Health Care Services Inc
• Josie A. Yanez, LMSW
• Samiya Yasin
• Nathan Yeh

• Diagnostic Radiology Physician in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Diagnostic Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; 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.