Individual
DR. IAN MEDORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1125
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD2016-0441
NM
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
MD2016-0441
NM
Other
Enumeration date
06/21/2010
Last updated
09/25/2024
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