Provider Demographics
NPI:1639193337
Name:TWIGGS, LEO B (MD)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:B
Last Name:TWIGGS
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 1:4610 JEFFERSON LN NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2117
Mailing Address - Country:US
Mailing Address - Phone:505-559-4495
Mailing Address - Fax:505-842-8025
Practice Address - Street 1:4610 JEFFERSON LN NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2117
Practice Address - Country:US
Practice Address - Phone:505-559-4495
Practice Address - Fax:505-842-8025
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85831207VX0201X
NMMD20120020207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM56759738Medicaid
FL2581868-00Medicaid
NMNMA102468Medicare UPIN
NM56759738Medicaid
FLD49021Medicare UPIN