Individual
DR. PETER ABRAHAM HEADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 242-3991
(505) 243-8405
Mailing address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4397
(505) 842-8171
(505) 246-0684
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD2013-0794
NM
208800000X
Urology Physician
Primary
MD2013-0794
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6305351
—
NM
01
—
MD2013-0794
MEDICAL LICENSE
NM
Enumeration date
04/28/2008
Last updated
04/21/2021
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