MR. Iredell Camuel Wyatt IV

NPI #1932430972 in North Bend, Oregon

Provider Information

NPI Number: 1932430972
Entity Type: Individual
Name: MR. Iredell Camuel Wyatt IV
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Technician, Other
Enumeration Date: Jan 14, 2010
Last Updated: Jan 14, 2010

Practice Location

Address: 2000 CONNECTICUT AVE
City: North Bend
State: Oregon
ZIP Code: 97459-2300
Phone: (541) 756-9234

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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