Healthcare Provider Details

I. General information

NPI: 1154767929
Provider Name (Legal Business Name): TU DAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 CENTRAL AVE SE
ALBUQUERQUE NM
87108-2408
US

IV. Provider business mailing address

2904 UNIVERSITY BLVD SE
ALBUQUERQUE NM
87106-5031
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5885
  • Fax:
Mailing address:
  • Phone: 505-903-6476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2015-0888
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: