Provider Demographics
NPI:1508884289
Name:KAUR, PRABHJOTE (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHJOTE
Middle Name:
Last Name:KAUR
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 1:201 CEDAR ST SE STE 800
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4912
Mailing Address - Country:US
Mailing Address - Phone:505-563-2800
Mailing Address - Fax:505-563-2821
Practice Address - Street 1:201 CEDAR ST SE STE 800
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4912
Practice Address - Country:US
Practice Address - Phone:505-563-2800
Practice Address - Fax:505-563-2821
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0354174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71357840Medicaid
NM71357840Medicaid
NMH54275Medicare UPIN