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NPI Code Detail

MEDICARE: DR. WENDELL WESTON SUMNER D.O.

MEDICARE: DR. WENDELL WESTON SUMNER D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianA-569-71NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295733467
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WENDELL WESTON SUMNER D.O.
Provider Business Mailing Address
First Line : 10110 SPAIN RD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87111-1965
Country : US
Telephone Number : 505-294-5065
Fax Number : 505-298-2731
Provider Business Practice Location Address
First Line : 10110 SPAIN RD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87111-1965
Country : US
Telephone Number : 505-294-5065
Fax Number : 505-298-2731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 10/26/2011

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