Provider Demographics
NPI:1336172998
Name:AAMODT, DENISE E (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:E
Last Name:AAMODT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26028
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6028
Mailing Address - Country:US
Mailing Address - Phone:505-262-7000
Mailing Address - Fax:505-262-7729
Practice Address - Street 1:1721 RIO RANCHO DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1570
Practice Address - Country:US
Practice Address - Phone:505-896-8600
Practice Address - Fax:505-869-8618
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
34K606006OtherMEDICARE PTAN
NMHO791Medicaid