Provider Demographics
NPI:1720006448
Name:ATTERBURY, BOUDINOT T (MD)
Entity Type:Individual
Prefix:
First Name:BOUDINOT
Middle Name:T
Last Name:ATTERBURY
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 1:1691 GALISTEO ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4780
Mailing Address - Country:US
Mailing Address - Phone:505-954-1921
Mailing Address - Fax:505-954-1922
Practice Address - Street 1:1691 GALISTEO ST
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4780
Practice Address - Country:US
Practice Address - Phone:505-954-1921
Practice Address - Fax:505-954-1922
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM88112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30751Medicaid
NM201000365OtherPRESBYTERIAN
NMNM013461OtherBCBS
NM30751Medicaid