Provider Demographics
NPI:1184980989
Name:BRITTAIN, PAUL ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALLEN
Last Name:BRITTAIN
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 1:715 DR MARTIN LUTHER KING JR AVE NE STE 102
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3666
Mailing Address - Country:US
Mailing Address - Phone:505-727-3040
Mailing Address - Fax:505-727-3099
Practice Address - Street 1:715 DR MARTIN LUTHER KING JR AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-727-3040
Practice Address - Fax:505-727-9590
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPENDING207RH0003X
390200000X
NMMD2018-0545207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24158038Medicaid