Provider Demographics
NPI:1568438752
Name:PACHECO, LEROY ARNOLD (MD)
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:ARNOLD
Last Name:PACHECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 UNIVERSITY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1710
Mailing Address - Country:US
Mailing Address - Phone:505-341-4148
Mailing Address - Fax:505-345-9914
Practice Address - Street 1:1617 UNIVERSITY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1710
Practice Address - Country:US
Practice Address - Phone:505-341-4148
Practice Address - Fax:505-345-9914
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM88-240207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12375Medicaid
F14762Medicare UPIN