Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 88-61 | NM |
NPI | 1245266261 |
---|---|
Provider Name | Charles R Pribyl |
First Address | Albuquerque, NM 87106-4917 |
Second Address | Albuquerque, NM 87106-4917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 10/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7039 | (05) | NM |
E12594 | (02) |