Provider Demographics
NPI:1790913200
Name:LINK, NATHANIEL EZRA (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:EZRA
Last Name:LINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4808 MCMAHON BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5010
Mailing Address - Country:US
Mailing Address - Phone:505-272-2900
Mailing Address - Fax:505-272-2909
Practice Address - Street 1:4808 MCMAHON BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5010
Practice Address - Country:US
Practice Address - Phone:505-272-2900
Practice Address - Fax:505-272-2909
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2023-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0606208000000X
NMRS2009-0280208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics