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General NPI Number Information
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NPI Number | 1871632315
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Entity Type | Organization
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Legal Business Name | WILLIAM M. WIXTED M.D., P.C.
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 731 BAY AVE
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City | SOMERS POINT
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State | NJ
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Zip | 08244-2342
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Country | US
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Telephone | 609-653-0199
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Fax | 609-653-9411
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Provider Business Mailing Address
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Address Line | 731 BAY AVE
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City | SOMERS POINT
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State | NJ
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Zip | 08244-2342
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Country | US
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Telephone | 609-653-0199
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Fax | 609-653-9411
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. WILLIAM M. WIXTED
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Credential | MD
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Telephone | 609-653-0199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 25MA02912900
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License Number State | NJ
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