Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 96338 | NM |
NPI | 1043243629 |
---|---|
Provider Name | Frank X Osullivan |
First Address | Albuquerque, NM 87125 |
Second Address | Albuquerque, NM 87108-4729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 12/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A13045 | (02) | |
K0721 | (05) | NM |