1396035556 NPI number — DR. BERNARD TAWFIK MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396035556 NPI number — DR. BERNARD TAWFIK MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TAWFIK

Provider First Name:

BERNARD

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1396035556

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/29/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

800 BRADBURY DR SE STE 116

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ALBUQUERQUE

Provider Business Mailing Address State Name:

NM

Provider Business Mailing Address Postal Code:

87106-4310

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

505-272-1476

Provider Business Mailing Address Fax Number:

505-272-8060

Provider First Line Business Practice Location Address:

UNM COMPREHENSIVE CANCER CENTER MSC07 4025

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ALBUQUERQUE

Provider Business Practice Location Address State Name:

NM

Provider Business Practice Location Address Postal Code:

87131

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

505-272-4946

Provider Business Practice Location Address Fax Number:

505-925-0100

Provider Enumeration Date:

04/08/2011

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  2014-00380 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: MD2018-0664 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RH0003X , with the licence number: Q3447 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RH0003X , with the licence number: MD2018-0664 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1869Z . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 4873989 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: P01368327 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: Q80014 . This is a "SC MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1396035556 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1396035556 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 1396035556 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 5116058 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".