Doctor Name: | DR. CATHERINE MARIE RADOVICH |
NPI Number: | 1699743328 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 91287 |
Business Practice Address: | 516 Nizhoni Blvd Gallup Indian Medical Center Gallup, NM - 873014555 |
Business Phone Number: | 5057221000 |
Business Fax Number: | |
Mailing Address: | Po Box 1337, Gallup Indian Medical Center GALLUP |
State: | NM |
Postal Code: | 87305 |
Phone Number: | 5057221000 |
Fax Number: | |
NPI Enumeration Date: | 03/09/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 91287 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |