Provider Demographics
NPI:1235335894
Name:BARRY D. NAGEL, MD, PC
Entity Type:Organization
Organization Name:BARRY D. NAGEL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-848-3124
Mailing Address - Street 1:1020 TIJERAS AVE NE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4749
Mailing Address - Country:US
Mailing Address - Phone:505-848-3124
Mailing Address - Fax:505-848-8077
Practice Address - Street 1:1020 TIJERAS AVE NE
Practice Address - Street 2:SUITE 22
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4749
Practice Address - Country:US
Practice Address - Phone:505-848-3124
Practice Address - Fax:505-848-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM73-230207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13201Medicaid
NMNM003124OtherBCBS
NMNM003124OtherBCBS