Healthcare Provider Details

I. General information

NPI: 1861434342
Provider Name (Legal Business Name): DONALD EDWARD PICHLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EUBANK BLVD NE SUITE F
ALBUQUERQUE NM
87111-3575
US

IV. Provider business mailing address

3825 EUBANK BLVD NE SUITE F
ALBUQUERQUE NM
87111-3575
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-4080
  • Fax: 505-292-1839
Mailing address:
  • Phone: 505-292-4080
  • Fax: 505-292-1839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number79-249
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: