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General NPI Number Information
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NPI Number | 1922018712
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Entity Type | Individual
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Provider Name | PHILLIP WILLIAM CARMODY MD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 10400 ACADEMY RD NE #230
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-1229
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Country | US
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Telephone | 505-298-1558
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Fax |
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Provider Business Mailing Address
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Address Line | 8906 BROCK LN NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3753
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Country | US
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Telephone | 505-858-0716
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 7415
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License Number State | NM
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