Individual
BJ DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3804 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1081
(505) 883-8099
(505) 883-8060
Mailing address
3804 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1081
(505) 883-8099
(505) 883-8060
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A40958
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2300559
MEDICARE PTAN
—
05
—
41723
—
NM
Enumeration date
12/07/2007
Last updated
12/07/2007
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