MILAGRO MEDICAL GROUP PC
Osteopathic Medicine at Elm St, Albuquerque, NM

License number
New Mexico PT0047621 FA0044101
Category
Osteopathic Medicine
Type
Hospitalist
Owner
Name: DAVID A GONZALES MD
Title: PRESIDENT - OWNER
Phone: (505) 577-8282
Address
Address 2
504 Elm St NE, Albuquerque, NM 87102
314 W Houghton St, Santa Fe, NM 87505
National Provider ID: 1548265713
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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MILAGRO MEDICAL GROUP, PC

Santa Fe, NM

Industry:
Medical Practice
Registration:
Jun 20, 2002
Addresses:
314 W Houghton  , Santa Fe, NM 87505 (Mailing)
314 W Houghton St, Santa Fe, NM 87505
State ID:
2258911
Business type:
Domestic Professional Corporation
Principals:
David Gonzales Md (President),David Gonzales (Principal)
Agent:
David Gonzales, M.d,314 W Houghton, Santa Fe, NM 87505 (Physical)

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