Individual
PHILLIP WILLIAM CARMODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10400 ACADEMY RD NE, #230, ALBUQUERQUE, NM 87111-1229
(505) 298-1558
Mailing address
8906 BROCK LN NE, ALBUQUERQUE, NM 87122-3753
(505) 858-0716
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
7415
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00007823
—
NM
Enumeration date
08/08/2006
Last updated
09/03/2013
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