Organization
ADVANCED GASTROENTEROLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AUTUMN L ROBERTS (PRACTICE MANAGER)
(505) 436-2906
Entity
Organization
Contact information
Practice address
4801 N BUTLER AVE, SUITE 13102, FARMINGTON, NM 87401-6002
(505) 436-2906
(505) 436-2197
Mailing address
4801 N BUTLER AVE, SUITE 13102, FARMINGTON, NM 87401-6002
(505) 436-2906
(505) 436-2197
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30177880
—
NM
01
—
792536
AHCCCS
NM
01
—
DT4411
RR MCR
NM
Enumeration date
06/03/2012
Last updated
04/21/2013
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