Provider Demographics
NPI:1619121548
Name:BADGER, WILLIAM EARL III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EARL
Last Name:BADGER
Suffix:III
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 1:800 CHAMISAL RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6408
Mailing Address - Country:US
Mailing Address - Phone:505-898-6660
Mailing Address - Fax:
Practice Address - Street 1:800 CHAMISAL RD NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6408
Practice Address - Country:US
Practice Address - Phone:505-898-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM67-33208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery