Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | T-1766 | NM |
NPI | 1063948123 |
---|---|
Provider Name | Paul Whitehouse |
First Address | Albuquerque, NM 87123-1095 |
Second Address | Albuquerque, NM 87108-5153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 11/05/2017 |