Healthcare Provider Details

I. General information

NPI: 1912048711
Provider Name (Legal Business Name): FOOT & ANKLE SPECIALISTS OF NEW MEXICO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 JUAN TABO BLVD NE
ALBUQUERQUE NM
87111-2672
US

IV. Provider business mailing address

5111 JUAN TABO BLVD NE
ALBUQUERQUE NM
87111-2672
US

V. Phone/Fax

Practice location:
  • Phone: 505-271-9900
  • Fax: 505-271-0217
Mailing address:
  • Phone: 505-271-9900
  • Fax: 505-271-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number212
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number212
License Number StateNM

VIII. Authorized Official

Name: DR. STEVEN S WREGE
Title or Position: OWNER
Credential: DPM
Phone: 505-271-9900