| Organization Name: | BLUE AND RED BIRD CORP PC |
| NPI Number: | 1548472830 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALI M GHAFFARI (MEDICAL DIRECTOR) |
| Mailing Address: | 815 W 14th St Clovis |
| State: | NM US |
| Postal Code: | 881015514 |
| Phone Number: | 5057626492 |
| Fax Number: | 5057698236 |
| NPI Enumeration Date: | 05/07/2007 |
| NPI Last Update Date: | 02/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |