Provider Demographics
NPI:1083000699
Name:RENAL AND INTERNAL MEDICINE CONSULTANT PC
Entity Type:Organization
Organization Name:RENAL AND INTERNAL MEDICINE CONSULTANT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-312-5822
Mailing Address - Street 1:4201 CENTRAL AVE NW
Mailing Address - Street 2:SUITE K-2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-1630
Mailing Address - Country:US
Mailing Address - Phone:505-639-5438
Mailing Address - Fax:505-544-2624
Practice Address - Street 1:4201 CENTRAL AVE NW
Practice Address - Street 2:SUITE K-2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1630
Practice Address - Country:US
Practice Address - Phone:505-639-5438
Practice Address - Fax:505-544-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM79-158207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty