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General NPI Number Information
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NPI Number | 1245380773
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Entity Type | Organization
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Legal Business Name | ALBUQUERQUE GASTROENTEROLOGY ASSOC PC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 200 OAK ST NE SUITE 1
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4740
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Country | US
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Telephone | 505-766-5471
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Fax | 505-766-6883
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Provider Business Mailing Address
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Address Line | 200 OAK ST NE SUITE 1
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4740
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Country | US
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Telephone | 505-766-5471
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Fax | 505-766-6883
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Authorized Official
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Title or Position | OWNER
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Name | VIJAY P AGARWAL
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Credential | MD
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Telephone | 505-766-5471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 89141
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License Number State | NM
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