Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 424 | NM |
N | 111NI0900X | Internist | 424 | NM |
Y | 111NN1001X | Nutrition | 424 | NM |
NPI | 1609991264 |
---|---|
Provider Name | Dr. Reginald G De Pelichy |
First Address | Albuquerque, NM 87123-9570 |
Second Address | Albuquerque, NM 87108-1446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 02/02/2008 |