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General NPI Number Information
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NPI Number | 1497740989
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Entity Type | Individual
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Provider Name | FRANK WILLIS WYANT JR. D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 806 DR. MLK JR. AVE., NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102
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Country | US
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Telephone | 505-842-6575
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Fax | 505-764-8796
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Provider Business Mailing Address
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Address Line | 8801 HORIZON BLVD NE SUITE 360
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1533
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Country | US
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Telephone | 505-828-4923
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Fax | 505-213-0103
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A-864-87
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License Number State | NM
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