Provider Demographics
NPI:1215131354
Name:WABOSO, FRANK
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:WABOSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 PINNACLE CIR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2537
Mailing Address - Country:US
Mailing Address - Phone:972-436-0601
Mailing Address - Fax:
Practice Address - Street 1:8120 CHANCELLOR ROW
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5512
Practice Address - Country:US
Practice Address - Phone:972-809-6883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program