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Individual

DR. MAX KENNETH WIANT JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4625 ALABAMA ST, SUITE B, EL PASO, TX 79930-2517
(915) 564-0411
(915) 562-5303
Mailing address
4625 ALABAMA ST, SUITE B, EL PASO, TX 79930-2517
(915) 564-0411
(915) 562-5303

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
F8733
TX
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
F8733
TX

Other

Enumeration date
09/05/2006
Last updated
08/18/2007
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