Individual
WALTER B FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8210 LOUISIANA BLVD. NE, SUITE C, ALBUQUERQUE, NM 87113-1761
(505) 858-1222
(505) 858-1224
Mailing address
8210 LOUISIANA BLVD. NE, SUITE C, ALBUQUERQUE, NM 87113-1761
(505) 858-1222
(505) 858-1224
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
88-168
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00006817
—
NM
Enumeration date
08/02/2006
Last updated
11/21/2011
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