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General NPI Number Information
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NPI Number | 1740646611
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Entity Type | Organization
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Legal Business Name | M D INJURY RELIEF CLINIC LLC
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Dates
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Enumeration Date | 01/08/2016
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 3311 CANDELARIA RD NE STE K
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-1952
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Country | US
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Telephone | 505-246-9190
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Fax |
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Provider Business Mailing Address
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Address Line | 3311 CANDELARIA RD NE STE K
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-1952
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Country | US
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Telephone | 505-246-9190
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS WHALEN
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Credential |
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Telephone | 505-246-9190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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