Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD2013-0032 | NM |
N | 207QS0010X | Family Doctor - Sports Medicine | MD26058 | OR |
NPI | 1336127836 |
---|---|
Provider Name | David C Phelps |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87109-3587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 09/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027892 | (05) | OR |
22371061 | (05) | NM |
I45329 | (02) |