1538333554 NPI number — ANTHONY FLEG MD, MPH

Table of content: ANTHONY FLEG MD, MPH (NPI 1538333554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538333554 NPI number — ANTHONY FLEG MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEG
Provider First Name:
ANTHONY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
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:
1538333554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 BRADBURY DR SE STE 116
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87106-4310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-1476
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 BORADMOOR BLVD NE
Provider Second Line Business Practice Location Address:
UNM SANDOVAL REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
RIO RANCHO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-994-7000
Provider Business Practice Location Address Fax Number:
505-552-5805
Provider Enumeration Date:
04/22/2008

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: 207Q00000X , with the licence number:  MD2011-0558 , 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: MD2011-0558 . This is a "NEW MEXICO MEDICAL BOARD STATE LICENSE NUMBER" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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