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General NPI Number Information
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NPI Number | 1568577229
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Entity Type | Organization
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Legal Business Name | WAYNE A DELAMATER MD PA
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 1606 SE MAIN ST
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City | ROSWELL
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State | NM
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Zip | 88203-5404
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Country | US
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Telephone | 575-624-0370
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Fax | 575-624-0376
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Provider Business Mailing Address
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Address Line | PO BOX 8190
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City | ROSWELL
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State | NM
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Zip | 88202-8190
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Country | US
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Telephone | 575-624-0370
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Fax | 575-624-0376
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARILYN HEIMMERMAN
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Credential |
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Telephone | 575-624-0370
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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 |
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License Number State |
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