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General NPI Number Information
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NPI Number | 1912950122
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Entity Type | Individual
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Provider Name | PAUL R. WHITWAM MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 601 W COUNTRY CLUB RD SUITE #102
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City | ROSWELL
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State | NM
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Zip | 88201-5224
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Country | US
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Telephone | 575-623-3333
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Fax | 575-624-4781
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Provider Business Mailing Address
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Address Line | 601 W COUNTRY CLUB RD SUITE #102
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City | ROSWELL
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State | NM
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Zip | 88201-5224
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Country | US
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Telephone | 575-623-3333
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Fax | 575-624-4781
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 73-226
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License Number State | NM
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