Provider Demographics
NPI:1144366287
Name:GOOD, GABRIELLA IMOGEN (MD)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:IMOGEN
Last Name:GOOD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:1101 MEDICAL ARTS AVE NE
Practice Address - Street 2:BUILDING 4, STE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2706
Practice Address - Country:US
Practice Address - Phone:505-272-1754
Practice Address - Fax:505-925-4594
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2017-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2847507OtherUHC
202025728OtherPRESBYTERIAN HEALTH PLANS
10036394OtherLOVELACE
NMNM001C41OtherBCBS NM
NMNM001C41OtherBCBS NM