Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD2013-0663 | NM |
NPI | 1174848808 |
---|---|
Provider Name | Mr. David G Stromberg |
First Address | Albuquerque, NM 87106-4375 |
Second Address | Albuquerque, NM 87131-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2010 |
Last Update Date | 27/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | CA |