Healthcare Provider Details

I. General information

NPI: 1336106335
Provider Name (Legal Business Name): PAUL DEAN AVRITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US

IV. Provider business mailing address

PO BOX 2432
CORRALES NM
87048-2432
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-4052
  • Fax:
Mailing address:
  • Phone: 505-898-6064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number87-203
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: