Healthcare Provider Details

I. General information

NPI: 1932293313
Provider Name (Legal Business Name): CHRISTOPHER R MIERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2405
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-4288
  • Fax: 505-275-4203
Mailing address:
  • Phone: 505-262-3135
  • Fax: 505-232-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number88-53
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: