Healthcare Provider Details

I. General information

NPI: 1164948279
Provider Name (Legal Business Name): W J KAFKA MD ANESTHESIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 INDIAN WELLS RD STE B
ALAMOGORDO NM
88310-4611
US

IV. Provider business mailing address

PO BOX 222187
EL PASO TX
79913-5187
US

V. Phone/Fax

Practice location:
  • Phone: 575-437-0890
  • Fax:
Mailing address:
  • Phone: 915-219-4300
  • Fax: 915-519-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM J KAFKA
Title or Position: OWNER/MD
Credential: MD
Phone: 575-644-0705