Organization
JAMES M. WILTERDING, M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES M. WILTERDING M.D. (OWNER)
(505) 265-2244
Entity
Organization
Contact information
Practice address
711 ENCINO PL NE, SUITE D, ALBUQUERQUE, NM 87102-2619
(505) 265-2244
(505) 265-0557
Mailing address
711 ENCINO PL NE, SUITE D, ALBUQUERQUE, NM 87102-2619
(505) 265-2244
(505) 265-0557
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
2003-0249
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61238015
—
NM
01
—
NM009M95
BLUE CROSS BLUE SHIELD
NM
01
—
PROVP16828
MOLINA SALUD
NM
Enumeration date
09/21/2006
Last updated
08/22/2020
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