Individual
DR. PAUL A ANTHONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4650 JEFFERSON LN NE, ALBUQUERQUE, NM 87109-2127
(505) 889-9639
(505) 889-2978
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01077206A
IN
2085R0001X
Radiation Oncology Physician
86-165
NM
2085R0203X
Therapeutic Radiology Physician
01077206A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
261909
AHCCCS
NM
01
—
300065574
MEDICARE RAILROAD
NM
05
—
37770
—
NM
01
—
5614250
AETNA/ PRONET
NM
01
—
9214
LOVELACE HEALTHPLAN
NM
01
—
92616
FIRST HEALTH PLAN
NM
01
—
NM000168
BLUE SHIELD/NM
NM
Enumeration date
06/14/2005
Last updated
01/25/2021
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