Healthcare Provider Details

I. General information

NPI: 1124118963
Provider Name (Legal Business Name): ROBERT THOMAS FERRARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 JEFFERSON ST NE SUITE #700
ALBUQUERQUE NM
87109-3478
US

IV. Provider business mailing address

5501 JEFFERSON ST NE SUITE #700
ALBUQUERQUE NM
87109-3478
US

V. Phone/Fax

Practice location:
  • Phone: 505-872-1002
  • Fax: 505-888-3708
Mailing address:
  • Phone: 505-872-1002
  • Fax: 505-888-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number93254
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number93-254
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: