Organization Name: | ANIMAS DERMATOLOGY MD PC |
NPI Number: | 1063576148 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEAN A GRAHAM (CEO) |
Mailing Address: | 4801 N Butler Ave Ste 9101 Farmington |
State: | NM US |
Postal Code: | 874013300 |
Phone Number: | 5053248375 |
Fax Number: | 5053274638 |
NPI Enumeration Date: | 12/21/2006 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 97-254 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | 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. |