Provider Demographics
NPI:1043304413
Name:BOBADILLA, ARNEL ANTHONY S (MD)
Entity Type:Individual
Prefix:
First Name:ARNEL ANTHONY
Middle Name:S
Last Name:BOBADILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:2200 W 21ST ST
Practice Address - Street 2:PLAINS REGIONAL MEDICAL GROUP
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-2011
Practice Address - Country:US
Practice Address - Phone:505-769-7577
Practice Address - Fax:505-769-7595
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2001139207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34956557Medicaid
348612203Medicare PIN
NM34956557Medicaid