Healthcare Provider Details

I. General information

NPI: 1023290160
Provider Name (Legal Business Name): WILLIAM J. WENGS, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 BOTULPH RD SUITE 500
SANTA FE NM
87505-1107
US

IV. Provider business mailing address

2009 BOTULPH RD SUITE 500
SANTA FE NM
87505-1107
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-2890
  • Fax: 505-986-2893
Mailing address:
  • Phone: 505-986-2890
  • Fax: 505-986-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number98414
License Number StateNM

VIII. Authorized Official

Name: DR. WILLIAM J WENGS
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 505-986-2890