Healthcare Provider Details

I. General information

NPI: 1770840035
Provider Name (Legal Business Name): PAUL E WILMETH D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 HIGHWAY 180 E
SILVER CITY NM
88061-7792
US

IV. Provider business mailing address

PO BOX 3049 2435 HWY 180 E
SILVER CITY NM
88062-3049
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-2581
  • Fax: 575-388-5060
Mailing address:
  • Phone: 575-388-2581
  • Fax: 575-388-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberCS00016995
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: