Healthcare Provider Details

I. General information

NPI: 1477513075
Provider Name (Legal Business Name): HALA ANNE MARIE TOUBBEH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 MONTGOMERY BLVD NE SUITE 102
ALBUQUERQUE NM
87109-1226
US

IV. Provider business mailing address

4001 INDIAN SCHOOL RD NE SUITE 325
ALBUQUERQUE NM
87110-3816
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7833
  • Fax: 505-727-6944
Mailing address:
  • Phone: 505-727-5785
  • Fax: 505-727-9770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number91-333
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberTL3127
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: