Healthcare Provider Details

I. General information

NPI: 1003822602
Provider Name (Legal Business Name): BRIAN R SCHWARTZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1-WEST SURGE 2701 FRONTIER NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

2701 FRONTIER NE MSC11 6120
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2610
  • Fax:
Mailing address:
  • Phone: 505-272-2610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR42985
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: