Individual
FREDERICK DUFF GRAMBORT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8308 CONSTITUTION PL NE, ALBUQUERQUE, NM 87110-7637
(505) 293-1333
(505) 293-4357
Mailing address
8308 CONSTITUTION PL NE, ALBUQUERQUE, NM 87110-7637
(505) 293-1333
(505) 293-4357
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
82-53
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003
CIMARRON HEALTH PLAN
NM
01
—
16218
PHP PROVIDER NUMBER
NM
01
—
NM001088
BCBS PROVIDER NUMBER
NM
Enumeration date
07/28/2005
Last updated
07/08/2007
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