Healthcare Provider Details

I. General information

NPI: 1134141260
Provider Name (Legal Business Name): KIRBY D GABRYS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/05/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5981 JEFFERSON ST NE STE A
ALBUQUERQUE NM
87109-3457
US

IV. Provider business mailing address

5981 JEFFERSON ST NE STE A
ALBUQUERQUE NM
87109-3457
US

V. Phone/Fax

Practice location:
  • Phone: 505-370-9600
  • Fax: 505-355-0566
Mailing address:
  • Phone: 505-370-9600
  • Fax: 505-355-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number94-249
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: