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Individual

DANIEL SHOVER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
PMG CEDAR PEDIATRIC GI, 201 CEDAR SE SUITE 302, ALBUQUERQUE, NM 87106
(505) 563-6550
(505) 563-6551
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD2005-0835
NM
2080P0206X
Pediatric Gastroenterology Physician
Primary
MD2005-0835
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
99752719
NM
Enumeration date
08/22/2005
Last updated
01/19/2016
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