Individual
DR. REX E MANIFOLD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1234
(505) 841-1956
Mailing address
1720 LOUISIANA BLVD NE, STE 401, ALBUQUERQUE, NM 87110-7020
(505) 260-4300
(505) 260-4338
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
87-264
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19959
—
NM
05
—
268153
—
AZ
05
—
39289
—
NM
05
—
5707722
—
VA
05
—
59276703
—
CO
01
—
961268
PRONET / AETNA
NM
01
—
NM009G14
BLUE CROSS BLUE SHEILD
NM
Enumeration date
05/27/2005
Last updated
07/09/2007
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