Healthcare Provider Details

I. General information

NPI: 1396742268
Provider Name (Legal Business Name): ROBERT Z FIALKOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4679
US

IV. Provider business mailing address

3821 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4679
US

V. Phone/Fax

Practice location:
  • Phone: 505-998-7400
  • Fax:
Mailing address:
  • Phone: 505-998-7400
  • Fax: 505-998-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number29160
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01040353A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2007022051
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD2004-0712
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: