Healthcare Provider Details

I. General information

NPI: 1942455910
Provider Name (Legal Business Name): ALBUQUERQUE ASSOCIATED PODIATRISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 ACADEMY RD NE STE C
ALBUQUERQUE NM
87111-1110
US

IV. Provider business mailing address

8080 ACADEMY RD NE STE C
ALBUQUERQUE NM
87111-1110
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 TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number325
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number136
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberNM181
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number308
License Number StateNM

VIII. Authorized Official

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