Healthcare Provider Details

I. General information

NPI: 1619121548
Provider Name (Legal Business Name): WILLIAM EARL BADGER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 12/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CHAMISAL RD NW
LOS RANCHOS NM
87107-6408
US

IV. Provider business mailing address

800 CHAMISAL RD NW
LOS RANCHOS NM
87107-6408
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-6660
  • Fax:
Mailing address:
  • Phone: 505-898-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number67-33
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: