Provider Demographics
NPI:1649363649
Name:WENGS, WILLIAM J (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:WENGS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2009 BOTULPH RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SANTE FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-986-2890
Mailing Address - Fax:505-986-2893
Practice Address - Street 1:2009 BOTULPH RD
Practice Address - Street 2:SUITE 500
Practice Address - City:SANTE FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-986-2890
Practice Address - Fax:505-986-2893
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM98-4142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT9528Medicaid
F26597Medicare UPIN
NMT9528Medicaid