Provider Demographics
NPI:1023124203
Name:HO, ANDY NGOC (DPM)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:NGOC
Last Name:HO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6727 ACADEMY RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3369
Mailing Address - Country:US
Mailing Address - Phone:505-881-1585
Mailing Address - Fax:505-828-3901
Practice Address - Street 1:6727 ACADEMY RD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3369
Practice Address - Country:US
Practice Address - Phone:505-341-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM287213E00000X
NM287213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM005491OtherBCBSNM
P00206089OtherRAIL ROAD
NM213E00000XMedicaid
U94451Medicare UPIN
NM213E00000XMedicaid
NM5337020001Medicare NSC