Basic Information
| Provider Information | |||||||||
| NPI: | 1629058599 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRUMINGER | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | BAIRD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 ENCINO PL NE STE F | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052721312 | ||||||||
| FaxNumber: | 5052722240 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 ENCINO PL NE STE F | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052721312 | ||||||||
| FaxNumber: | 5052722240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 03/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301074075 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | NM2013-0849 | NM | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 59203765 | 05 | NM | MEDICAID | 48485349 | 05 | CO | MEDICAID | 718497 | 05 | AZ | MEDICAID |