Healthcare Provider Details

I. General information

NPI: 1114074457
Provider Name (Legal Business Name): NEW MEXICO GYNECOLOGY CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE., NE SUITE 203
ALBUQUERQUE NM
87109-4597
US

IV. Provider business mailing address

4901 LANG AVE., NE SUITE 203
ALBUQUERQUE NM
87109-4597
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-5353
  • Fax: 505-242-9788
Mailing address:
  • Phone: 505-242-5353
  • Fax: 505-242-9788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK B FISK III
Title or Position: CO-OWNER
Credential:
Phone: 505-242-5353