Provider Demographics
NPI:1780718155
Name:ORTHOPAEDIC BONE & JOINT SPECIALISTS PA
Entity type:Organization
Organization Name:ORTHOPAEDIC BONE & JOINT SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-242-2764
Mailing Address - Street 1:700 LOMAS BLVD NE
Mailing Address - Street 2:ONE WOODWARD CENTER
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2568
Mailing Address - Country:US
Mailing Address - Phone:505-242-2764
Mailing Address - Fax:505-247-3265
Practice Address - Street 1:700 LOMAS BLVD NE
Practice Address - Street 2:ONE WOODWARD CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2568
Practice Address - Country:US
Practice Address - Phone:505-242-2764
Practice Address - Fax:505-247-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMFA0003587207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ1965Medicaid
NMZ1965Medicaid