Provider Demographics
NPI:1053467126
Name:WALCHER, JOSEPH BENJAMIN II (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BENJAMIN
Last Name:WALCHER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 666
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88311-0666
Mailing Address - Country:US
Mailing Address - Phone:575-551-5111
Mailing Address - Fax:575-551-5112
Practice Address - Street 1:1211 E. EIGHTH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:575-551-5111
Practice Address - Fax:575-551-5112
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM73-221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM26237Medicaid
NM850240201OtherTAX ID
NM26237Medicaid