Organization Name: | LOS ALAMOS FAMILY PRACTICE P A |
NPI Number: | 1285857664 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PHILLIP ALAN HERTZMAN (PRESIDENT) |
Mailing Address: | 3917 West Rd Suite 130 Los Alamos |
State: | NM US |
Postal Code: | 875442275 |
Phone Number: | 5056622900 |
Fax Number: | |
NPI Enumeration Date: | 04/11/2007 |
NPI Last Update Date: | 11/01/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0505X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Adult Medicine |
Taxonomy Definition: |