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Individual

DR. MARVIN ANTONIO PORFIRO SISON DUQUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4495
(505) 842-8171
Mailing address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4495
(505) 842-8171

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
242096
MA
207RH0003X
Hematology & Oncology Physician
MD2016-0099
NM
208M00000X
Hospitalist Physician
016621A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200934840
IN
05
76806057
NM
Enumeration date
09/12/2008
Last updated
05/10/2016
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