Healthcare Provider Details

I. General information

NPI: 1952324238
Provider Name (Legal Business Name): F ADELE BLAKELY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON SE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

PO BOX 27829
ALBUQUERQUE NM
87125
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-7000
  • Fax:
Mailing address:
  • Phone: 505-232-1920
  • Fax: 505-727-9276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number77135
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: