Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1141 | NM |
NPI | 1417946153 |
---|---|
Provider Name | Dr. Michael Pendleton |
First Address | Albuquerque, NM 87109-1521 |
Second Address | Albuquerque, NM 87109-1521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2005 |
Last Update Date | 08/07/2007 |