Healthcare Provider Details

I. General information

NPI: 1912990151
Provider Name (Legal Business Name): DERMATOLOGY CONSULTANTS OF ALBUQUERQUE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 KASEMAN CT NE
ALBUQUERQUE NM
87110-7639
US

IV. Provider business mailing address

8316 KASEMAN CT NE
ALBUQUERQUE NM
87110-7639
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-5850
  • Fax: 505-292-9724
Mailing address:
  • Phone: 505-292-5850
  • Fax: 505-292-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM G CHAPMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 505-292-5850