Healthcare Provider Details

I. General information

NPI: 1134390073
Provider Name (Legal Business Name): GARY D PRANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 MENAUL BLVD NE STE D
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

7700 MENAUL BLVD NE STE D
ALBUQUERQUE NM
87110-4639
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-4487
  • Fax: 505-299-4498
Mailing address:
  • Phone: 505-299-4487
  • Fax: 505-299-4498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GARY D PRANT
Title or Position: PODIATRIST OWNER
Credential: DPM
Phone: 505-299-4487