Provider Demographics
NPI:1992006167
Name:ELMER J PACHECO MD
Entity Type:Organization
Organization Name:ELMER J PACHECO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-697-9271
Mailing Address - Street 1:4801 MCMAHON BLVD NW
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5090
Mailing Address - Country:US
Mailing Address - Phone:505-922-1111
Mailing Address - Fax:505-922-1115
Practice Address - Street 1:4801 MCMAHON BLVD NW
Practice Address - Street 2:SUITE 235
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5090
Practice Address - Country:US
Practice Address - Phone:505-922-1111
Practice Address - Fax:505-922-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty