Healthcare Provider Details

I. General information

NPI: 1043226780
Provider Name (Legal Business Name): LINDA J BUTROS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 CARLISLE BLVD NE
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

1516 GRAY ROCK PL NE
ALBUQUERQUE NM
87112-6639
US

V. Phone/Fax

Practice location:
  • Phone: 505-636-0728
  • Fax: 505-212-4132
Mailing address:
  • Phone: 505-636-0728
  • Fax: 505-212-4132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD2004-0511
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: