Organization
WESTERN DERMATOLOGY CONSULTANTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE GLASS MD (PRESIDENT)
(505) 855-5503
Entity
Organization
Contact information
Practice address
10151 MONTGOMERY BLVD NE, BLDG. 1 STE. A, ALBUQUERQUE, NM 87111-3670
(505) 855-5503
Mailing address
10151 MONTGOMERY NE BLDG. 1, STE. A, ALBUQUERQUE, NM 87111
(505) 855-5503
(505) 855-5533
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P6441
—
NM
Enumeration date
03/07/2007
Last updated
03/06/2008
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