1275528606 NPI number — FRANK DURSO M.D.

Table of content: FRANK DURSO M.D. (NPI 1275528606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275528606 NPI number — FRANK DURSO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURSO
Provider First Name:
FRANK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275528606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8801 HORIZON BLVD NE
Provider Second Line Business Mailing Address:
SUITE 360
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87113-1533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-828-4923
Provider Business Mailing Address Fax Number:
505-213-0103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5757 HARPER DRIVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-888-5757
Provider Business Practice Location Address Fax Number:
505-889-3589
Provider Enumeration Date:
09/12/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  80-142 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NM000780 . This is a "BC BS OF NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 15149 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91-801423 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180014475 . This is a "RRB MEDICARE RAILROAD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 252528 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".