Healthcare Provider Details

I. General information

NPI: 1922219203
Provider Name (Legal Business Name): ALBUQUERQUE ASSOCIATED PODIATRISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SYCAMORE ST NE
ALBUQUERQUE NM
87106-4622
US

IV. Provider business mailing address

121 SYCAMORE ST NE
ALBUQUERQUE NM
87106-4622
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4164
  • Fax: 505-247-4561
Mailing address:
  • Phone: 505-247-4164
  • Fax: 505-247-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number136
License Number StateNM

VIII. Authorized Official

Name: MARK HAAS
Title or Position: DR OWNER
Credential:
Phone: 505-247-4164