Individual
ELIZABETH KOFFLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
454 SAINT MICHAELS DR STE 200, SANTA FE, NM 87505-7602
(505) 303-5000
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2020-0930
NM
390200000X
Student in an Organized Health Care Education/Training Program
MT213571
PA
Other
Enumeration date
06/13/2017
Last updated
09/28/2020
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