Healthcare Provider Details

I. General information

NPI: 1689689150
Provider Name (Legal Business Name): DANIEL WASCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2ND AMBULATORY CARE CTR 2211 LOMAS BLVD. NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

2211 LOMAS BLVD NE MSC10 5600
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1623
  • Fax:
Mailing address:
  • Phone: 505-272-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number91-342
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: