| NPI | 1740688548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUE CALLIS Credentialing Assistant 575-207-8890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2013-0738) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2015-01-22 |