Individual
DR. KRISTIAN BERNARD GOULET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MB, BCH, BAO
Contact information
Practice address
MSC 08, 1 UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM 87131-0001
(505) 272-6225
Mailing address
6533 MESA MARIPOSA PL NW, ALBUQUERQUE, NM 87120-3364
(505) 856-2166
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
243449
MA
208000000X
Pediatrics Physician
Primary
RS20070321
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RS20070321
STATE LICENCE NUMBER
NM
Enumeration date
06/27/2007
Last updated
06/18/2010
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