Healthcare Provider Details

I. General information

NPI: 1477552958
Provider Name (Legal Business Name): GABRIELLE ADAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7788 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4342
US

IV. Provider business mailing address

7788 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4342
US

V. Phone/Fax

Practice location:
  • Phone: 505-999-1600
  • Fax: 505-999-1653
Mailing address:
  • Phone: 505-999-1600
  • Fax: 505-999-1653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number97-176
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: