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Contact Information

WALTER B FORMAN, MD
8210 LOUISIANA BLVD. NE
SUITE C
ALBUQUERQUE, NM87113-1761
 Phone: 505-858-1222
 Fax: 505-858-1224
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for WALTER B FORMAN · (Male)

NPI # 1417964453
Status Active
Credentials MD
Entity Individual
Enumeration date 08/02/2006
Last updated 11/21/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • NM License # 88-168
  • NM Medicaid 00006817
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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