Healthcare Provider Details

I. General information

NPI: 1225271083
Provider Name (Legal Business Name): GALEN CASTILLO LOUGHREY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GONZALES RD SW FIRST CHOICE COMMUNITY HEALTHCARE - ALAMOSA MEDICAL
ALBUQUERQUE NM
87121-2401
US

IV. Provider business mailing address

6900 GONZALES RD SW
ALBUQUERQUE NM
87121
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-2534
  • Fax: 505-831-4123
Mailing address:
  • Phone: 505-831-2534
  • Fax: 505-831-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2011-0622
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: