Healthcare Provider Details

I. General information

NPI: 1073838785
Provider Name (Legal Business Name): ALEMAYEHU GEBISSA BIFFA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2310
US

IV. Provider business mailing address

8800 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2310
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-6400
  • Fax: 505-462-6458
Mailing address:
  • Phone: 505-462-6400
  • Fax: 505-462-6458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2013-0155
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: