Provider Demographics
NPI:1437130226
Name:WENDLER, FREDERICK W JR (MD)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:W
Last Name:WENDLER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N SILVER STREET
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061
Mailing Address - Country:US
Mailing Address - Phone:575-388-3175
Mailing Address - Fax:575-388-4695
Practice Address - Street 1:2600 N SILVER STREET
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-388-3175
Practice Address - Fax:575-388-4695
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89-327174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18283Medicaid
NM18283Medicaid