Individual
DR. GARY LEE KASELONIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4701 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1219
(505) 727-8104
Mailing address
PO BOX 452036, SUNRISE, FL 33345-2036
(954) 838-2371
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
MD2004-0776
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23833238
—
NM
Enumeration date
12/07/2005
Last updated
07/08/2007
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