Healthcare Provider Details

I. General information

NPI: 1922449974
Provider Name (Legal Business Name): MIRZA MOAZAM BEG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2013
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

8300 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7613
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2222
  • Fax: 505-291-2440
Mailing address:
  • Phone: 505-291-2222
  • Fax: 505-291-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD2017-1061
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: