Provider Demographics
NPI:1063439800
Name:ALBUQUERQUE WOMEN'S HEALTH, PC
Entity type:Organization
Organization Name:ALBUQUERQUE WOMEN'S HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-842-5902
Mailing Address - Street 1:1010 LEAD AVE SE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-5214
Mailing Address - Country:US
Mailing Address - Phone:505-842-5902
Mailing Address - Fax:505-242-6313
Practice Address - Street 1:1010 LEAD AVE SE
Practice Address - Street 2:SUITE 4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-5214
Practice Address - Country:US
Practice Address - Phone:505-842-5902
Practice Address - Fax:505-242-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM9363207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95822739Medicaid
NM95822739Medicaid