Individual
DR. GAUTAM KISHORE VALECHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
8300 CONSTITUTION AVE NE, ALBUQUERQUE, NM 87110-7613
(505) 559-6100
(505) 559-6101
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
MD2020-0359
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/28/2013
Last updated
06/23/2020
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