Healthcare Provider Details

I. General information

NPI: 1780178608
Provider Name (Legal Business Name): MR. BYRON DWAYNE AKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 YALE BLVD SE STE F
ALBUQUERQUE NM
87106-4228
US

IV. Provider business mailing address

PO BOX 25445
ALBUQUERQUE NM
87125-0445
US

V. Phone/Fax

Practice location:
  • Phone: 505-804-7354
  • Fax:
Mailing address:
  • Phone: 505-766-5197
  • Fax: 505-766-6945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: