MEDICARE: PAMELA J DAFFERN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101059354	VA
2	207K00000X	Allergy & Immunology Physician	0101059354	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1598933145	OTHER	NM	GROUP NPI
2	1396970281	OTHER	VA	GROUP NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043309107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA J DAFFERN MD

Provider Business Mailing Address
First Line	:	1020 TIJERAS AVE NE
Second Line	:	SUITE 22
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4749
Country	:	US
Telephone Number	:	505-848-3124
Fax Number	:	505-843-9037

Provider Business Practice Location Address
First Line	:	1020 TIJERAS AVE NE
Second Line	:	SUITE 22
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4749
Country	:	US
Telephone Number	:	505-848-3124
Fax Number	:	505-843-9037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	03/03/2016

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Directions to “ PAMELA J DAFFERN MD” Practice Location

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