Healthcare Provider Details

I. General information

NPI: 1598753246
Provider Name (Legal Business Name): NEW MEXICO EAR NOSE & THROAT SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 EDITH BLVD NE
ALBUQUERQUE NM
87102-2509
US

IV. Provider business mailing address

401 EDITH BLVD NE
ALBUQUERQUE NM
87102-2509
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-8030
  • Fax: 505-842-1158
Mailing address:
  • Phone: 505-243-8030
  • Fax: 505-842-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK FIBER
Title or Position: PRESIDENT
Credential: MD
Phone: 505-243-8030