Healthcare Provider Details

I. General information

NPI: 1952377004
Provider Name (Legal Business Name): RICHARD CHARLES GARTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR ST. VINCENT HOSPITALIST GROUP
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

455 SAINT MICHAELS DR ST. VINCENT HOSPITALIST GROUP
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-6130
  • Fax: 505-820-5408
Mailing address:
  • Phone: 505-989-6130
  • Fax: 505-820-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number81827
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2011-0698
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: