MEDICARE: SOUTHWEST ENDOCRINE CONSULTANTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CT1353	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205839594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST ENDOCRINE CONSULTANTS

Provider Business Mailing Address
First Line	:	1201 E SCHUSTER AVE
Second Line	:	BLDG 7
City	:	EL PASO
State	:	TX
Zip	:	79902-4660
Country	:	US
Telephone Number	:	915-533-5486
Fax Number	:	915-533-9602

Provider Business Practice Location Address
First Line	:	1201 E SCHUSTER AVE
Second Line	:	BLDG 7
City	:	EL PASO
State	:	TX
Zip	:	79902-4660
Country	:	US
Telephone Number	:	915-533-5486
Fax Number	:	915-533-9602

Authorized Official
Title or Position	:	ENDOCRINOLOGIST
Name	:	WILBUR J STRADER
Credential	:	M.D.
Telephone Number	:	915-533-5486

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	11/12/2007

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Directions to “SOUTHWEST ENDOCRINE CONSULTANTS ” Practice Location

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