Healthcare Provider Details

I. General information

NPI: 1407879703
Provider Name (Legal Business Name): BRENT FRAME DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 JUAN TABO BLVD NE
ALBUQUERQUE NM
87111-2672
US

IV. Provider business mailing address

5111 JUAN TABO BLVD NE
ALBUQUERQUE NM
87111-2672
US

V. Phone/Fax

Practice location:
  • Phone: 505-880-1000
  • Fax: 505-880-1002
Mailing address:
  • Phone: 505-880-1000
  • Fax: 505-880-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number222
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: