Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MD2006-0295 | NM |
NPI | 1013947639 |
---|---|
Provider Name | Dr. Brendan J Cavanaugh |
First Address | Albuquerque, NM 87102-2512 |
Second Address | Albuquerque, NM 87102-2512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 28/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (02) | |
PENDING | (05) | NM |