Healthcare Provider Details

I. General information

NPI: 1568577229
Provider Name (Legal Business Name): WAYNE A DELAMATER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 SE MAIN ST
ROSWELL NM
88203-5404
US

IV. Provider business mailing address

PO BOX 8190
ROSWELL NM
88202-8190
US

V. Phone/Fax

Practice location:
  • Phone: 575-624-0370
  • Fax: 575-624-0376
Mailing address:
  • Phone: 575-624-0370
  • Fax: 575-624-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARILYN HEIMMERMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 575-624-0370