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ANIMAS DERMATOLOGY MD PC NPI 1063576148


NPI Information

NPI: 1063576148
Provider Name: ANIMAS DERMATOLOGY MD PC
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
4801 N BUTLER AVE STE 9101
FARMINGTON, NM
ZIP 87401
Phone: (505) 324-8375
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ANIMAS DERMATOLOGY MD PC is a specialist in Farmington, NM. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. ANIMAS DERMATOLOGY MD PC NPI is 1063576148. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4801 N BUTLER AVE STE 9101
FARMINGTON, NM
ZIP 87401-300
Phone: (505) 324-8375
Fax: (505) 327-4638

The provider's authorized official is Jean A Graham .
The authorized official title is Ceo and has the following contact phone number (505) 324-8375.

The enumeration date for this NPI number is 12/21/2006 and was last updated on 8/17/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialist97-254NEW MEXICOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1=========OTHERNEW MEXICOTRICARE
2Q2833MEDICAIDNEW MEXICO
3=========-001OTHERCOLORADOROCKY MT HMO
4NM012425OTHERNEW MEXICOBLUE CROSS BLUE SHIELD NM

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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