Individual
DR. JACK GEORGE GHABLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7001 SIGNAL AVE NE, ALBUQUERQUE, NM 87113-2453
(505) 856-2735
(505) 856-2749
Mailing address
DEPT. 453 PO BOX 1000, MEMPHIS, TN 38148-0001
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
MD2017-0386
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
584457AC7E
MEDICARE PTAN
NM
05
—
82000727
—
NM
Enumeration date
04/05/2012
Last updated
10/30/2023
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