Healthcare Provider Details

I. General information

NPI: 1043380496
Provider Name (Legal Business Name): PATRIC YVES NASSAUX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13214 CEDARBROOK AVE NE
ALBUQUERQUE NM
87111-3022
US

IV. Provider business mailing address

4501 MORRIS ST NE APT. 178
ALBUQUERQUE NM
87111-3790
US

V. Phone/Fax

Practice location:
  • Phone: 505-920-0473
  • Fax: 505-920-0473
Mailing address:
  • Phone: 505-332-9748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberH8277
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: