Healthcare Provider Details

I. General information

NPI: 1659570950
Provider Name (Legal Business Name): WILLIAM G. LOUTFY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 ACADEMY RD NE #230
ALBUQUERQUE NM
87111-1229
US

IV. Provider business mailing address

10400 ACADEMY RD NE #230
ALBUQUERQUE NM
87111-1229
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-4900
  • Fax: 505-299-4991
Mailing address:
  • Phone: 505-299-4900
  • Fax: 505-299-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number95-283
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: