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General NPI Number Information
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NPI Number | 1073752127
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Entity Type | Organization
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Legal Business Name | DARLO G VANDER WILT DPM
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 718 LOMAS BLVD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2073
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Country | US
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Telephone | 505-843-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 718 LOMAS BLVD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2073
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Country | US
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Telephone | 505-843-6464
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. DARLO VANDER WILT
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Credential | DPM
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Telephone | 505-843-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 099
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License Number State | NM
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