Healthcare Provider Details

I. General information

NPI: 1669433017
Provider Name (Legal Business Name): WILLIAM M ROETHEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MARTIN LUTHER KING AVE NE
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

601 MARTIN LUTHER KING AVE NE
ALBUQUERQUE NM
87102-3619
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-8000
  • Fax:
Mailing address:
  • Phone: 505-727-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2006-0621
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4301054529
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: