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General NPI Number Information
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NPI Number | 1659520823
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Entity Type | Individual
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Provider Name | MARVIN ANTONIO PORFIRO SISON DUQUE M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2008
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 4901 LANG AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4495
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Country | US
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Telephone | 505-842-8171
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Fax |
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Provider Business Mailing Address
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Address Line | 4901 LANG AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4495
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Country | US
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Telephone | 505-842-8171
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 016621A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 242096
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD2016-0099
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License Number State | NM
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