Healthcare Provider Details

I. General information

NPI: 1407824972
Provider Name (Legal Business Name): JEFFREY HEBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE LOVELACE MEDICAL CENTER
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

PO BOX 4934
ALBUQUERQUE NM
87196-4934
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-0301
  • Fax: 505-554-3302
Mailing address:
  • Phone: 505-298-0301
  • Fax: 505-554-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-53638
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD2006-0138
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21526
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC196208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: