Healthcare Provider Details

I. General information

NPI: 1720123847
Provider Name (Legal Business Name): CHEST MEDICINE OF NEW MEXICO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4273 MONTGOMERY BLVD NE SUITE 200 EAST
ALBUQUERQUE NM
87109-6748
US

IV. Provider business mailing address

4273 MONTGOMERY BLVD NE SUITE 200 EAST
ALBUQUERQUE NM
87109-6748
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-5992
  • Fax: 505-821-6692
Mailing address:
  • Phone: 505-821-5992
  • Fax: 505-821-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY M DORF
Title or Position: PRESIDENT
Credential: MD
Phone: 505-821-5992