Individual
PAMELA J DAFFERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1020 TIJERAS AVE NE, SUITE 22, ALBUQUERQUE, NM 87106-4749
(505) 848-3124
(505) 843-9037
Mailing address
1020 TIJERAS AVE NE, SUITE 22, ALBUQUERQUE, NM 87106-4749
(505) 848-3124
(505) 843-9037
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
0101059354
VA
207R00000X
Internal Medicine Physician
0101059354
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396970281
GROUP NPI
VA
01
—
1598933145
GROUP NPI
NM
05
—
94507520
—
NM
Enumeration date
10/12/2006
Last updated
03/03/2016
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