Provider Demographics
NPI:1134134695
Name:SMALL, MAUREEN D (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:D
Last Name:SMALL
Suffix:
Gender:F
Credentials:MD
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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:PMG URGENT CARE
Practice Address - Street 2:5901 HARPER DRIVE NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-823-8519
Practice Address - Fax:505-823-8355
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-08-14
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Provider Licenses
StateLicense IDTaxonomies
NM87-370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000E4456Medicaid
F20641Medicare UPIN
NM000E4456Medicaid