Organization
PREMIER ANESTHESIA OF NEW MEXICO, LLP
Active
Organization
PREMIER ANESTHESIA OF NEW MEXICO, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY GORDON MD (OWNER)
(505) 292-9200
Entity
Organization
Contact information
Practice address
1720 WYOMING BLVD NE, ALBUQUERQUE, NM 87112-3855
(505) 292-9200
Mailing address
PO BOX 52194, DEPT 987, PHOENIX, AZ 85072-2194
(575) 532-7000
(575) 532-7006
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78986575
—
NM
01
—
NM007G66
BLUE CROSS BLUE SHEILD
NM
Enumeration date
06/09/2005
Last updated
06/10/2010
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