Healthcare Provider Details

I. General information

NPI: 1023367588
Provider Name (Legal Business Name): ANDREW GAFFNEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WALTER ST NE SUITE 401
ALBUQUERQUE NM
87102-2534
US

IV. Provider business mailing address

4411 MEDICAL DR STE 300
SAN ANTONIO TX
78229-3824
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-7451
  • Fax: 505-262-7870
Mailing address:
  • Phone: 210-614-5400
  • Fax: 210-614-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12001
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: