Provider Demographics
NPI:1548261498
Name:HYATT, WAYNE PARIS JR (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:PARIS
Last Name:HYATT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MEDICAL PARK DR E
Mailing Address - Street 2:STE 211
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3430
Mailing Address - Country:US
Mailing Address - Phone:205-838-3696
Mailing Address - Fax:
Practice Address - Street 1:52 MEDICAL PARK DR E
Practice Address - Street 2:STE 211
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3430
Practice Address - Country:US
Practice Address - Phone:205-838-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9374207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051079027OtherBCBS
AL000038008Medicaid
AL051038008OtherBCBS
TN0166467OtherBCBS-TN
AL051004329OtherBCBS
AL924810OtherBLOCK VISION
ALC75187OtherVIVA HEALTH
AL000079027Medicaid
AL009999680Medicaid
ALC75187OtherHEALTHSPRINGS OF AL
AL0810099OtherUNITEDHEALTHCARE
ALC75187OtherVIVA HEALTH
AL000079027Medicare PIN
C75187Medicare UPIN
TN0166467OtherBCBS-TN
AL009999680Medicaid
AL0669280001Medicare NSC
AL000038008Medicare PIN