Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD2004-0511 | NM |
NPI | 1043226780 |
---|---|
Provider Name | Linda J Butros |
First Address | Albuquerque, NM 87112-6639 |
Second Address | Albuquerque, NM 87110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 21/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02071843 | (05) | NM |