Healthcare Provider Details

I. General information

NPI: 1265527444
Provider Name (Legal Business Name): ELIZABETH HUME MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE FL 5 PMG CEDAR OBGYN
ALBUQUERQUE NM
87106-4917
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-6000
  • Fax: 505-563-6060
Mailing address:
  • Phone: 505-923-6770
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number78-189
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: