Provider Demographics
NPI:1699846147
Name:UROLOGY GROUP OF NEW MEXICO, PC
Entity type:Organization
Organization Name:UROLOGY GROUP OF NEW MEXICO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SNOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-872-4090
Mailing Address - Street 1:4161 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6742
Mailing Address - Country:US
Mailing Address - Phone:505-872-4090
Mailing Address - Fax:505-872-4097
Practice Address - Street 1:4161 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6742
Practice Address - Country:US
Practice Address - Phone:505-872-4090
Practice Address - Fax:505-872-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM021487880000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========Medicare ID - Type Unspecified