Healthcare Provider Details

I. General information

NPI: 1124033683
Provider Name (Legal Business Name): MARCOS BURGOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH AMBULATORY CARE CTR 2211 LOMAS BLVD. NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

2211 LOMAS BLVD NE MSC10 5550
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1863
  • Fax:
Mailing address:
  • Phone: 505-272-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2002-0466
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: