Healthcare Provider Details

I. General information

NPI: 1538555461
Provider Name (Legal Business Name): ROBERTO AGUERO BLAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N POPE ST
SILVER CITY NM
88061-5161
US

IV. Provider business mailing address

1007 N POPE ST
SILVER CITY NM
88061-5161
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1511
  • Fax:
Mailing address:
  • Phone:
  • Fax: 888-368-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRS2015-0330
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD2019-1096
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2019-1096
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: