Individual
WILLIAM BRENT WAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11600 WEST 2ND PLACE, LAKEWOOD, CO 80228
(720) 321-0000
(720) 321-1621
Mailing address
1819 DENVER WEST DRIVE, STE. 101, LAKEWOOD, CO 80401
(303) 223-4457
(303) 964-1438
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
32653
CO
207R00000X
Internal Medicine Physician
DR.0032653
CO
2085R0202X
Diagnostic Radiology Physician
Primary
DR.0032653
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01326537
—
CO
01
—
300049148
RAILROAD MEDICARE
CO
Enumeration date
06/28/2006
Last updated
11/18/2016
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