Healthcare Provider Details

I. General information

NPI: 1922074632
Provider Name (Legal Business Name): WILLIAM J. KAFKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
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 Number88-31
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: