Healthcare Provider Details

I. General information

NPI: 1861633265
Provider Name (Legal Business Name): IURI STANISLAV GOLUBEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 THE 25 WAY NE STE 325
ALBUQUERQUE NM
87109-5853
US

IV. Provider business mailing address

4411 THE 25 WAY NE STE 325
ALBUQUERQUE NM
87109-5853
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-4411
  • Fax: 505-343-6085
Mailing address:
  • Phone: 505-823-4411
  • Fax: 505-213-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD2014-0885
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: