Individual
KEVIN GOODLUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4600 MONTGOMERY BLVD NE, BLDG B, STE 100, ALBUQUERQUE, NM 87109
(505) 924-5840
(505) 924-5841
Mailing address
PO BOX 91224, ALBUQUERQUE, NM 87199-1224
(505) 924-5840
(505) 924-5841
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
97-251
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81783311
—
NM
Enumeration date
10/03/2006
Last updated
01/12/2021
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