Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 39456 | IA |
NPI | 1023342466 |
---|---|
Provider Name | Rubens Barros Costa Filho |
First Address | Albuquerque, NM 87102-3661 |
Second Address | Albuquerque, NM 87102-3661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2009 |
Last Update Date | 22/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023342466 | (05) | IA |