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1447246095

NPI Code Detail

MEDICARE: SAMUEL DOUGLAS MACBRIDE MD

MEDICARE: SAMUEL DOUGLAS MACBRIDE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	MD2005-0662	NM
2	207Q00000X	Family Medicine Physician	MD2005-0662	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447246095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL DOUGLAS MACBRIDE MD

Provider Business Mailing Address
First Line	:	800 BRADBURY DR SE STE 116
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4310
Country	:	US
Telephone Number	:	505-272-1476
Fax Number	:	505-726-8740

Provider Business Practice Location Address
First Line	:	3001 BROADMOOR BLVD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-2100
Country	:	US
Telephone Number	:	505-994-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	10/18/2025

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Directions to “ SAMUEL DOUGLAS MACBRIDE MD” Practice Location

Language	Start Address	Practice Location

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