Provider Demographics
NPI:1912038688
Name:ALBUQUERQUE FAMILY AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:ALBUQUERQUE FAMILY AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BAIR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:505-872-8727
Mailing Address - Street 1:101 HOSPITAL LOOP NE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2129
Mailing Address - Country:US
Mailing Address - Phone:505-872-8727
Mailing Address - Fax:505-872-8728
Practice Address - Street 1:101 HOSPITAL LOOP NE
Practice Address - Street 2:SUITE 209
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2129
Practice Address - Country:US
Practice Address - Phone:505-872-8727
Practice Address - Fax:505-872-8728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-710-80207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME1002Medicaid
NME1002Medicaid