Healthcare Provider Details

I. General information

NPI: 1386872497
Provider Name (Legal Business Name): GREGG WILLIAM SCHMEDES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE 2ND FLOOR
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

1620 N MAIN ST
SPANISH FORK UT
84660-1008
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2336
  • Fax:
Mailing address:
  • Phone: 801-822-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD20160873
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberLL31983
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: