Healthcare Provider Details

I. General information

NPI: 1417964479
Provider Name (Legal Business Name): GREGORY MERTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WALTER ST NE SUITE 104
ALBUQUERQUE NM
87102-2534
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-848-3730
  • Fax: 505-217-2727
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-217-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number83-257
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: