Healthcare Provider Details

I. General information

NPI: 1871681247
Provider Name (Legal Business Name): TERESA L RUTLEDGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CAMINO DE SALUD NE
ALBUQUERQUE NM
87102-4517
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-0461
  • Fax: 505-925-0454
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-925-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD2007-0696
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: