Provider Demographics
NPI:1457686511
Name:CURTIS, BAYLE R (PA-C)
Entity Type:Individual
Prefix:
First Name:BAYLE
Middle Name:R
Last Name:CURTIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 MORNINGRISE PL SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4520
Mailing Address - Country:US
Mailing Address - Phone:505-363-8336
Mailing Address - Fax:
Practice Address - Street 1:1806 MORNINGRISE PL SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4520
Practice Address - Country:US
Practice Address - Phone:505-363-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2009-0026363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical