Individual
OLE ANTHONY PELOSO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 ENCINO PL NE, STE C12, ALBUQUERQUE, NM 87102-2612
(505) 247-4849
(505) 247-4850
Mailing address
1600 SIGMA CHI RD NE, ALBUQUERQUE, NM 87106-4550
(505) 242-5504
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
6965
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21337
—
NM
01
—
23312
PHP
—
01
—
NM012133
BCBS
—
Enumeration date
09/22/2005
Last updated
07/08/2007
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