Provider Demographics
NPI:1225197700
Name:BRETTON, ELIZABETH MORE (MD,)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MORE
Last Name:BRETTON
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 ENCINO PLACE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-224-7400
Mailing Address - Fax:505-224-7404
Practice Address - Street 1:717 ENCINO PLACE NE
Practice Address - Street 2:SUITE 24
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-224-7400
Practice Address - Fax:505-224-7404
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM93-221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF68495Medicare UPIN