Provider Demographics
NPI:1710977905
Name:PALEN, BRIAN NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:NICHOLAS
Last Name:PALEN
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 1:2803 MONTEREY AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2940
Mailing Address - Country:US
Mailing Address - Phone:505-232-2988
Mailing Address - Fax:505-846-3295
Practice Address - Street 1:2803 MONTEREY AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2940
Practice Address - Country:US
Practice Address - Phone:505-232-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine