Individual
MANIDEEP GOTUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4005 HIGH RESORT BLVD SE, RIO RANCHO, NM 87124-5906
(505) 462-6000
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD2016-0014
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/21/2014
Last updated
06/27/2016
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