# MILAGRO MEDICAL GROUP PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548265713
- **Authorized official:** DAVID A GONZALES MD (PRESIDENT - OWNER)
- **Authorized official phone:** (505) 577-8282

## Contact information

- **Practice address:** 504 ELM ST NE, ALBUQUERQUE, NM 87102-2512
- **Practice address phone:** (505) 724-2005
- **Practice address fax:** (505) 843-2931
- **Mailing address:** 314 W HOUGHTON ST, SANTA FE, NM 87505-8849
- **Mailing address phone:** (505) 577-8282
- **Mailing address fax:** (505) 843-2931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208M00000X | Hospitalist Physician | PT0047621 FA0044101 | NM | Yes |

## Other

- **Enumeration date:** 06/15/2005
- **Last updated:** 09/07/2010