Individual
AMY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
PMG PEDIATRIC SURGICAL GROUP, 201 CEDAR SE SUITE 503, ALBUQUERQUE, NM 87106
(505) 224-7478
(505) 224-7479
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
208600000X
Surgery Physician
Primary
R19892
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7036205
—
NM
Enumeration date
10/03/2006
Last updated
08/19/2008
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