Healthcare Provider Details

I. General information

NPI: 1861836413
Provider Name (Legal Business Name): CARL CONNORS OBGYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 MONTGOMERY BLVD NE STE 105
ALBUQUERQUE NM
87109-1246
US

IV. Provider business mailing address

4705 MONTGOMERY BLVD NE STE 105
ALBUQUERQUE NM
87109-1246
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-3280
  • Fax: 505-727-3282
Mailing address:
  • Phone: 505-727-3280
  • Fax: 505-727-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA-913-90
License Number StateNM

VIII. Authorized Official

Name: CARL J CONNORS
Title or Position: PRESIDENT
Credential: DO
Phone: 505-727-3280