Provider Demographics
NPI:1629214838
Name:NEW MEXICO PLASTIC SURGEONS, PC
Entity Type:Organization
Organization Name:NEW MEXICO PLASTIC SURGEONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:S
Authorized Official - Last Name:TSAO-WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-842-6868
Mailing Address - Street 1:1020 TIJERAS AVE NE
Mailing Address - Street 2:STE. 16
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4749
Mailing Address - Country:US
Mailing Address - Phone:505-842-6868
Mailing Address - Fax:505-842-9325
Practice Address - Street 1:1020 TIJERAS AVE NE
Practice Address - Street 2:STE. 16
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4749
Practice Address - Country:US
Practice Address - Phone:505-842-6868
Practice Address - Fax:505-842-9325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT00984342086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58905863Medicaid