Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 99-60 | NM |
NPI | 1003823048 |
---|---|
Provider Name | Anne Jones |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87110-7613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 24/02/2020 |