Individual
FRANK WILLIS WYANT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
806 DR. MLK JR. AVE., NE, ALBUQUERQUE, NM 87102
(505) 842-6575
(505) 764-8796
Mailing address
8801 HORIZON BLVD NE, SUITE 360, ALBUQUERQUE, NM 87113-1533
(505) 828-4923
(505) 213-0103
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A-864-87
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180014481
RRB MEDICARE RAILROAD
NM
05
—
279712
—
AZ
05
—
40394
—
NM
01
—
NM004657
BC BS OF NM
NM
Enumeration date
09/12/2005
Last updated
04/25/2008
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