Provider Demographics
NPI:1184819633
Name:GAMMILL, WENDELL DERRY (LMT)
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:DERRY
Last Name:GAMMILL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 ACADEMY RD NE
Mailing Address - Street 2:#313
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1229
Mailing Address - Country:US
Mailing Address - Phone:505-822-8440
Mailing Address - Fax:
Practice Address - Street 1:10400 ACADEMY RD NE
Practice Address - Street 2:#313
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1229
Practice Address - Country:US
Practice Address - Phone:505-822-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5529174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist