Individual
WILLIAM M WIXTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
731 BAY AVE, SOMERS POINT, NJ 08244-2342
(609) 653-1863
(609) 601-1406
Mailing address
731 BAY AVE, SOMERS POINT, NJ 08244-2342
(609) 653-1863
(609) 601-1406
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
25MA02912900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
222205797
TAX ID
NJ
01
—
25MA02912900
STATE LICENSE
NJ
Enumeration date
06/05/2006
Last updated
07/09/2007
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