DR. KENNETH EGERSTROM (NPI# 1497739098) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497739098 |
| Entity Type | Individual |
| Full Name | DR. KENNETH EGERSTROM |
| Credential | MD |
| Practice Address |
2050a 2nd St Se Kirtland Afb NM 87117-5522 |
| Practice Telephone | 5058467695 |
| Mailing Telephone | 5058467695 |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2009-07-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 0101222073 | VA | Allopathic & Osteopathic Physicians |
| Y | 2083A0100X |
Preventive Medicine Specialization: Aerospace Medicine |
0101222073 | VA | Allopathic & Osteopathic Physicians |
| Street Address |
2050A 2ND ST SE |
| City | KIRTLAND AFB |
| State | NM |
| Zip Code | 87117-5522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841273109 | Mylene Tran Huynh | Family Medicine | 2050a 2nd St Se, Kirtland Afb, NM 87117-5522 | 2005-11-21 |
| 1295103265 | Adam David Myers | Physician Assistant | 2050a 2nd St Se, Kirtland Afb, NM 87117-5522 | 2015-09-09 |
| 1184943623 | Todd Burbach | Military Health Care Provider | 2050a 2nd St Se, Kirtland Afb, NM 87117-5000 | 2010-05-24 |
| 1366671570 | William James Negri | Military Health Care Provider | 2050a 2nd St Se, 377amds/sgpf, Kirtland Afb, NM 87117-5522 | 2009-07-09 |
| 1073610820 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | 2050a 2nd St Se, Kirtland Afb, NM 87117-5524 | 2006-09-20 |
| 1316906993 | George Eric Womble | Registered Nurse | 2050a 2nd St Se, Kirtland Afb, NM 87117-5522 | 2006-03-21 |
| 1114990280 | Mary Ann Terese Orzech | Preventive Medicine | 2050a 2nd St Se, Kirtland Afb, NM 87117-5522 | 2006-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245614544 | Rowland Coyle | Military Health Care Provider | 701 Stephen Moody Rd, Albuquerque, NM 87117 | 2015-07-16 |
| 1649619511 | National Vision Optical | Technician/Technologist | 7901 Gibson Blvd, Bldg 20176, Kirtland, NM 87117 | 2013-06-24 |
| 1437493020 | Sarah Michael Workman | Nurse Practitioner | 1501 San Pedro Drive Se, Bld 47, 377mdg/mdos/sgow, Albuquerque, NM 87117 | 2012-11-20 |
| 1871852210 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | Kirtland Afb Building 20170, Albuquerque, NM 87117 | 2012-05-04 |
| 1528180502 | Gay C Davis | Speech-Language Pathologist | 25000 East Kirtland Afb, Wherry Es, Albuquerque, NM 87117 | 2007-04-03 |
| 1952493017 | Angela Marie Albrecht | Family Medicine | 377 Medical Group 2050 A Second St Se, Albuquerque, NM 87117 | 2006-09-28 |
| 1104930734 | Lesley Dale Pacheco | Social Worker | 2050 A 2nd Street, Kirtland Afb, NM 87117 | 2006-08-19 |
| 1053355735 | Joseph Agage Ouma | Family Medicine | 377th Mdg, Kirtland Afb, 2050 A Second St, Se, Albuquerque, NM 87117 | 2006-06-15 |
| 1033762927 | Mary Mauldin | Registered Nurse | 1515 Eubank Blvd, Albuquerque, NM 87117 | 2019-07-19 |
| 1811540834 | Angie Leigh Avila-quigley | Registered Nurse | 1515 Eubank, Albuquerque, NM 87117 | 2019-07-18 |
| Find all providers in zip 87117 | ||||
| Taxonomy Code | 2083A0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Aerospace Medicine |
| Aerospace medicine focuses on the clinical care, research, and operational support of the health, safety, and performance of crewmembers and passengers of air and space vehicles, together with the support personnel who assist operation of such vehicles. This population often works and lives in remote, isolated, extreme, or enclosed environments under conditions of physical and psychological stress. Practitioners strive for an optimal human-machine match in occupational settings rich with environmental hazards and engineering countermeasures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. American Osteopathic Board of Preventive Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629043310 | Thomas D. Fadell Luna | Preventive Medicine | 2050 A Second St., Se, 377 Mdg/sgp, Kirtland Afb, NM 87117-5522 | 2006-02-17 |
| 1134192917 | Paul A. Young | Preventive Medicine | 2050a Second Street Se, Kirtland Afb, NM 87117-5522 | 2006-02-10 |
| 1114990280 | Mary Ann Terese Orzech | Preventive Medicine | 2050a 2nd St Se, Kirtland Afb, NM 87117-5522 | 2006-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639580574 | Joseph Abraham Parks | Preventive Medicine | Msc Physical Medicine & Rehabilitation, 1 University of New Mexico, Albuquerque, NM 87131 | 2014-05-14 |
| 1174502090 | Richard James Serkowski | Preventive Medicine | 511 N Torch Blvd, Bldg 300, Cannon Afb, NM 88103-5109 | 2006-01-10 |
| 1912465402 | Nicolas Ferry | Preventive Medicine | 1501 San Pedro Dr Se, Albuquerque, NM 87108-5180 | 2019-03-04 |
| 1558504068 | Logan D Jones | Preventive Medicine | 208 W Casablanca Ave Bldg 1400, Cannon Afb, NM 88103-5009 | 2009-04-14 |
| 1548477284 | Clarence Edward Cotton Jr. | Preventive Medicine | 27 Medical Group, Clovis, NM 88103-5014 | 2007-05-16 |
| 1609914431 | David A Sarnow | Preventive Medicine | 208 W Casablanca Ave, 27 Somdg/flight Medicine, Bldg 1400, Cannon Afb, NM 88103-5014 | 2007-02-02 |
| 1326035676 | Walter Mark Matthews | Preventive Medicine | 208 W Casablanca Cannon Afb, Bldg 1400 27 Medical Group, Clovis, NM 88103-5014 | 2005-10-03 |
| City | KIRTLAND AFB |
| Zip Code | 87117 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.