Healthcare Provider Details

I. General information

NPI: 1124049531
Provider Name (Legal Business Name): BRIAN SCOTT CAREY D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4619 GREENE ST NW SUITE D
ALBUQUERQUE NM
87114-4895
US

IV. Provider business mailing address

6119 MUSTANG LN NW
ALBUQUERQUE NM
87120-2289
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-9378
  • Fax:
Mailing address:
  • Phone: 505-298-8724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number869
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: