Healthcare Provider Details

I. General information

NPI: 1942576145
Provider Name (Legal Business Name): DOUGLAS JAMES ALDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 THE 25 WAY NE
ALBUQUERQUE NM
87109-5857
US

IV. Provider business mailing address

373 BIG HORN RIDGE DR NE
ALBUQUERQUE NM
87122-1424
US

V. Phone/Fax

Practice location:
  • Phone: 505-328-2604
  • Fax:
Mailing address:
  • Phone: 505-328-2604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD2014-0889
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: