Healthcare Provider Details

I. General information

NPI: 1649363649
Provider Name (Legal Business Name): WILLIAM J WENGS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 BOTULPH RD SUITE 500
SANTE FE NM
87505
US

IV. Provider business mailing address

2009 BOTULPH RD SUITE 500
SANTE FE NM
87505
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 Code2084N0400X
TaxonomyNeurology Physician
License Number98-414
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: