MEDICARE: DR. BARRY RALPH MARON 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	207X00000X	Orthopaedic Surgery Physician	71177	NM

General Provider Information

NPI Number	:	1952349755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY RALPH MARON MD

Provider Business Mailing Address
First Line	:	7125 TICONDEROGA RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-5041
Country	:	US
Telephone Number	:	505-821-7936
Fax Number	:	505-796-0402

Provider Business Practice Location Address
First Line	:	927 SAN PEDRO DR SE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-4981
Country	:	US
Telephone Number	:	505-265-4000
Fax Number	:

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/08/2007

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