Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DD1288 | NM |
Y | 213EG0000X | General Practice | DD1288 | NM |
NPI | 1003037581 |
---|---|
Provider Name | Dr. William G Wolfe |
First Address | Albuquerque, NM 87112 |
Second Address | Santa Fe, NM 87507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |