Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 20030692 | NM |
NPI | 1013001486 |
---|---|
Provider Name | Richard L Converse |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87106-4921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 15/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2651858 | (05) | NM |
341413210 | (02) | NM |
F67190 | (02) |