Healthcare Provider Details

I. General information

NPI: 1235139569
Provider Name (Legal Business Name): WILLIAM G CHAPMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 KASEMAN CT NE
ALBUQUERQUE NM
87110-7639
US

IV. Provider business mailing address

8316 KASEMAN CT NE
ALBUQUERQUE NM
87110-7639
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-5850
  • Fax: 505-292-9724
Mailing address:
  • Phone: 505-292-5850
  • Fax: 505-292-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number79-143
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: