Individual
RONALD A LISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1101 CENTRAL SE, PMG EMERGENCY MEDICINE, ALBUQUERQUE, NM 87106
(505) 841-1125
(505) 841-1737
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
99-249
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000Z6361
—
NM
Enumeration date
08/30/2006
Last updated
08/15/2008
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