Individual
ALFRED A. VAN BAAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
8300 CONSTITUTION AVE NE BLDG D, ALBUQUERQUE, NM 87110-7613
(505) 291-2730
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD2016-0051
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07431210
—
NM
Enumeration date
07/04/2011
Last updated
06/03/2019
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