Tom Wulf MD LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

TOM WULF MD LLC

Practice address

607 W Country Club Rd
Roswell, NM 88201-5211

Phone

(575) 208-7795

Fax

(575) 208-7785

NPI assigned

Feb 10, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thomas Wulf, MD

Title

Owner

Phone

(575) 208-7795

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1407488182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 W COUNTRY CLUB RD STE 15",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015804",
            "telephone_number": "575-208-7795",
            "fax_number": "575-208-7785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W COUNTRY CLUB RD",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015211",
            "telephone_number": "575-208-7795",
            "fax_number": "575-208-7785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOM WULF MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-10",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "WULF",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "575-208-7795",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42637716",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Roswell, NM
• Providers in Roswell, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.