Provider Demographics
NPI:1831374610
Name:ALI, CYRUS (MD)
Entity type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1630 HOSPITAL DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4772
Mailing Address - Country:US
Mailing Address - Phone:505-913-3975
Mailing Address - Fax:505-986-8001
Practice Address - Street 1:1630 HOSPITAL DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4772
Practice Address - Country:US
Practice Address - Phone:505-913-3975
Practice Address - Fax:505-986-8001
Is Sole Proprietor?:No
Enumeration Date:2007-12-30
Last Update Date:2013-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2009-0197208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM302255Medicare PIN