Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 91-320 | NM |
NPI | 1043226657 |
---|---|
Provider Name | Phillip Strange |
First Address | Albuquerque, NM 87106-4375 |
Second Address | Albuquerque, NM 87102-2708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 02/02/2012 |