Provider Demographics
NPI:1902990393
Name:PINON, IVAN G (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:G
Last Name:PINON
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:201 CEDAR ST SE STE 46304TH
Practice Address - Street 2:PMG CEDAR ENDOCRINOLOGY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4917
Practice Address - Country:US
Practice Address - Phone:505-563-6400
Practice Address - Fax:505-563-6409
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM94356207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35378824Medicaid
341405009Medicare PIN
NM35378824Medicaid