Healthcare Provider Details

I. General information

NPI: 1770706459
Provider Name (Legal Business Name): ALEXEI GENNADIEVICH BAKHIREV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1995
  • Fax: 505-841-1373
Mailing address:
  • Phone: 505-841-1995
  • Fax: 505-841-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberMD2011-0852
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD2011-0852
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: