Healthcare Provider Details

I. General information

NPI: 1194923938
Provider Name (Legal Business Name): SOUTHWEST ENDOCRINOLOGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 JEFFERSON ST NE SUITE #700
ALBUQUERQUE NM
87109-3478
US

IV. Provider business mailing address

5501 JEFFERSON ST NE SUITE #700
ALBUQUERQUE NM
87109-3478
US

V. Phone/Fax

Practice location:
  • Phone: 505-872-1002
  • Fax: 505-888-3708
Mailing address:
  • Phone: 505-872-1002
  • Fax: 505-888-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberNM95274
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number93-254
License Number StateNM

VIII. Authorized Official

Name: ROBERT THOMAS FERRARO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 505-872-1002