Organization
ALBUQUERQUE DERMATOLOGY ASSOCIATES, PA
Active
Organization
ALBUQUERQUE DERMATOLOGY ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ESTELLE B MILLER (PRACTICE MANAGER)
(505) 872-4700
Entity
Organization
Contact information
Practice address
4610 JEFFERSON LN NE, ALBUQUERQUE, NM 87109-2117
(505) 872-4700
(505) 872-4709
Mailing address
4610 JEFFERSON LN NE, ALBUQUERQUE, NM 87109-2117
(505) 872-4700
(505) 872-4709
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2000-166
NM
207N00000X
Dermatology Physician
2002-0450
NM
207N00000X
Dermatology Physician
MD2005-0405
NM
207N00000X
Dermatology Physician
R46867NM
NM
207ND0101X
MOHS-Micrographic Surgery Physician
2000-166
NM
207NS0135X
Procedural Dermatology Physician
2000-166
NM
207NS0135X
Procedural Dermatology Physician
2002-0450
NM
207NS0135X
Procedural Dermatology Physician
MD2005-0405
NM
207NS0135X
Procedural Dermatology Physician
R46867NM
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44792
—
NM
05
—
47235306
—
NM
05
—
76659755
—
NM
05
—
93885865
—
NM
05
—
F1418
—
NM
Enumeration date
05/28/2006
Last updated
03/06/2008
Update your record
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