Healthcare Provider Details

I. General information

NPI: 1265912828
Provider Name (Legal Business Name): SALAH ZUHAIR SAID MAHMOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 03/17/2025
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SAN MATEO BLVD SE
ALBUQUERQUE NM
87108-2921
US

IV. Provider business mailing address

PO BOX 26666 PROVIDER ENROLLMENT
ALBUQUERQUE NM
87131-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-7333
  • Fax: 505-462-7440
Mailing address:
  • Phone: 505-923-6770
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2020-0823
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: