Wilson, Glen P
Wilson, Glen P is an individual health care provider with primary practice located at 4901 Lang Ave Ne , Albuquerque NM 87109-4495. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Wilson, Glen P can be contacted via phone (505) 842-8171.Contact Information
Primary practice address
4901 Lang Ave Ne
Albuquerque NM 87109-4495
Phone: (505) 842-8171
Fax: (505) 857-3877
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 2000-314 | New Mexico |
Profile Details
| NPI number | 1285638999 |
|---|---|
| LBN Legal business name | Wilson, Glen P |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 9th, 2005 |
| Last updated | Oct 30th, 2024 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1285638999 | NPPES |
| New Mexico | MEDICAID | L0634 | |
| New Mexico | Other | 600521002 | |
| New Mexico | Other | 700521102 | |
| New Mexico | Other | 2258272 | |
| New Mexico | MEDICAID | 45138 | |
| New Mexico | MEDICAID | 52713 | |
| New Mexico | MEDICAID | 66463 | |
| New Mexico | Other | 800521126 |
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