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General NPI Number Information
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NPI Number | 1912038688
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Entity Type | Organization
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Legal Business Name | ALBUQUERQUE FAMILY AND SPORTS MEDICINE
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 101 HOSPITAL LOOP NE SUITE 209
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2129
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Country | US
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Telephone | 505-872-8727
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Fax | 505-872-8728
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Provider Business Mailing Address
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Address Line | 101 HOSPITAL LOOP NE SUITE 209
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2129
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Country | US
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Telephone | 505-872-8727
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Fax | 505-872-8728
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT DEAN BAIR JR.
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Credential | D.O
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Telephone | 505-872-8727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | A-710-80
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License Number State | NM
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