Individual
JEFFREY DORNBUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 CENTRAL AVE SE, PMG PEDS INTENSIVISTS, ALBUQUERQUE, NM 87106-4930
(505) 724-7044
(505) 841-1462
Mailing address
1100 CENTRAL AVE SE, PICU, 6TH FLOOR, PMG PEDIATRIC INTENSIVISTS, ALBUQUERQUE, NM 87106-4930
(505) 724-7044
(505) 841-1462
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
92-42
NM
2080P0203X
Pediatric Critical Care Medicine Physician
92-42
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E2508
—
NM
Enumeration date
08/30/2006
Last updated
03/30/2016
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