Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 277026-1205 | UT |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 2000-131 | NM |
NPI | 1528046885 |
---|---|
Provider Name | Dr. Michael J Archibeck |
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 | 06/01/2006 |
Last Update Date | 16/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00079305 | (05) | NM |
H09291 | (02) |