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General NPI Number Information
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NPI Number | 1336302801
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Entity Type | Individual
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Provider Name | SETH KAGAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2008
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 3001 BROADMOOR BLVD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-2100
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Country | US
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Telephone | 505-994-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1613 CAMINO DE LA SIERRA NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-4937
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Country | US
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Telephone | 408-673-7384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD2016-0613
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License Number State | NM
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