Healthcare Provider Details

I. General information

NPI: 1073519138
Provider Name (Legal Business Name): FRANK EDWARD WAECHTER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 06/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MAIN ST SUITE A
PAYSON AZ
85541-5618
US

IV. Provider business mailing address

PO BOX 859
PAYSON AZ
85547-0859
US

V. Phone/Fax

Practice location:
  • Phone: 928-474-9744
  • Fax: 928-474-9766
Mailing address:
  • Phone: 928-474-9744
  • Fax: 928-474-9766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberM0333
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: