Provider Demographics
NPI:1043380496
Name:NASSAUX, PATRIC YVES (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRIC
Middle Name:YVES
Last Name:NASSAUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4501 MORRIS ST NE
Mailing Address - Street 2:APT. 178
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3790
Mailing Address - Country:US
Mailing Address - Phone:505-332-9748
Mailing Address - Fax:
Practice Address - Street 1:2050A SECOND STREET SE,
Practice Address - Street 2:
Practice Address - City:KIRTLAND AFB
Practice Address - State:NM
Practice Address - Zip Code:87111-5522
Practice Address - Country:US
Practice Address - Phone:505-853-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8277207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH8277OtherLICENSE