Individual
MR. MICHAEL GERARD LA BELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
40 GARDEN PARK CIR NW, ALBUQUERQUE, NM 87107-2669
(505) 385-4060
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
90-PA23
NM
363AM0700X
Medical Physician Assistant
90PA23
NM
Other
Enumeration date
11/27/2006
Last updated
02/05/2018
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