Healthcare Provider Details

I. General information

NPI: 1932200904
Provider Name (Legal Business Name): EDUARDO A. ALAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PLACE N.E. SUITE 26
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

717 ENCINO PLACE N.E. SUITE 26
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-4545
  • Fax: 505-884-4114
Mailing address:
  • Phone: 505-884-4545
  • Fax: 505-884-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD20050840
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: