Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086X0206X | Surgical Oncologist | MD2013-0237 | NM |
N | 208C00000X | Colorectal Surgeon | M5153 | TX |
NPI | 1124066824 |
---|---|
Provider Name | Bridget N Fahy |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87131-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 02/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
187993402 | (05) | TX |
187993403 | (05) | TX |
8W1055 | BLUE CROSS BLUE SHIELD (01) | TX |
P00427639 | RAILROAD MEDICARE (01) | TX |
P01123931 | RR MEDICARE (01) | TX |