Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 2002-0192 | NM |
N | 207RX0202X | Medical Oncology | 2002-0192 | NM |
NPI | 1013940675 |
---|---|
Provider Name | Bernard M Agbemadzo |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 20/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50057804 | (05) | NM |
H63403 | (02) |