Healthcare Provider Details

I. General information

NPI: 1063439800
Provider Name (Legal Business Name): ALBUQUERQUE WOMEN'S HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LEAD AVE SE SUITE 4
ALBUQUERQUE NM
87106-5214
US

IV. Provider business mailing address

1010 LEAD AVE SE SUITE 4
ALBUQUERQUE NM
87106-5214
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-5902
  • Fax: 505-242-6313
Mailing address:
  • Phone: 505-842-5902
  • Fax: 505-242-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9363
License Number StateNM

VIII. Authorized Official

Name: ROBERT A GORDON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 505-842-5902