Healthcare Provider Details

I. General information

NPI: 1922190040
Provider Name (Legal Business Name): CHARLES F PACE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/24/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 MCMAHON BLVD NW SUITE 119
ALBUQUERQUE NM
87114-5412
US

IV. Provider business mailing address

4824 MCMAHON BLVD NW SUITE 119
ALBUQUERQUE NM
87114-5412
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-1595
  • Fax: 505-898-0846
Mailing address:
  • Phone: 505-898-1595
  • Fax: 505-898-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2000-259
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: