Healthcare Provider Details

I. General information

NPI: 1003875089
Provider Name (Legal Business Name): KELLY DRESCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 5600
ALBUQUERQUE NM
87106-4920
US

IV. Provider business mailing address

201 CEDAR ST SE STE 5600
ALBUQUERQUE NM
87106-4920
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-6000
  • Fax: 505-563-6060
Mailing address:
  • Phone: 55-563-6000
  • Fax: 505-563-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD2007-0256
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: