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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