Individual
ROY DALE MCDONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.C.O.
Contact information
Practice address
4117 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1102
(505) 884-2927
(505) 884-2672
Mailing address
4117 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1102
(505) 884-2927
(505) 884-2672
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T2326
—
NM
Enumeration date
09/25/2006
Last updated
07/09/2007
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