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General NPI Number Information
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NPI Number | 1073519138
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Entity Type | Individual
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Provider Name | FRANK EDWARD WAECHTER III MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 06/29/2013
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Provider Practice Location Address
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Address Line | 120 E MAIN ST SUITE A
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City | PAYSON
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State | AZ
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Zip | 85541-5618
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Country | US
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Telephone | 928-474-9744
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Fax | 928-474-9766
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Provider Business Mailing Address
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Address Line | PO BOX 859
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City | PAYSON
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State | AZ
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Zip | 85547-0859
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Country | US
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Telephone | 928-474-9744
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Fax | 928-474-9766
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | M0333
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License Number State | TX
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