Healthcare Provider Details

I. General information

NPI: 1922017730
Provider Name (Legal Business Name): BARRY D NAGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 TIJERAS AVE NE SUITE 22
ALBUQUERQUE NM
87106-4749
US

IV. Provider business mailing address

1020 TIJERAS AVE NE STE 22
ALBUQUERQUE NM
87106-4749
US

V. Phone/Fax

Practice location:
  • Phone: 505-848-3124
  • Fax: 505-848-8077
Mailing address:
  • Phone: 505-848-3124
  • Fax: 505-727-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number78-230
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: