Provider Demographics
NPI:1780650986
Name:VALDEZ-BOYLE, LORENE S (MD)
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:S
Last Name:VALDEZ-BOYLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:801 ENCINO PL, NE SUITE C1
Mailing Address - Street 2:UNMHSC SPECIALTY EXTENSION SERVICES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-272-0110
Mailing Address - Fax:505-272-2360
Practice Address - Street 1:801 ENCINO PL, NE SUITE C1
Practice Address - Street 2:UNMHSC SPECIALTY EXTENSION SERVICES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-272-0110
Practice Address - Fax:505-272-2360
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-09-06
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM20050754208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI47245Medicare UPIN