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General NPI Number Information
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NPI Number | 1174622666
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Entity Type | Organization
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Legal Business Name | JAMES M. WILTERDING, M.D., LLC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 711 ENCINO PL NE SUITE D
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2619
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Country | US
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Telephone | 505-265-2244
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Fax | 505-265-0557
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Provider Business Mailing Address
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Address Line | 711 ENCINO PL NE SUITE D
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2619
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Country | US
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Telephone | 505-265-2244
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Fax | 505-265-0557
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Authorized Official
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Title or Position | OWNER
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Name | JAMES M. WILTERDING
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Credential | M.D.
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Telephone | 505-265-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2003-0249
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License Number State | NM
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