Healthcare Provider Details

I. General information

NPI: 1417993445
Provider Name (Legal Business Name): THEODORE LAWRENCE VAROZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 C CANDELARIA NW
ALBUQUERQUE NM
87107-2766
US

IV. Provider business mailing address

1204 C CANDELARIA NW
ALBUQUERQUE NM
87107-2766
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-8529
  • Fax: 505-345-6410
Mailing address:
  • Phone: 505-345-8529
  • Fax: 505-345-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number219
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number219
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: