Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 70-208 | NM |
N | 207RA0201X | Internist - Allergy & Immunology | 70-208 | NM |
NPI | 1629040407 |
---|---|
Provider Name | Bruce D. Tempest |
First Address | Gallup, NM 87301-5683 |
Second Address | Gallup, NM 87301-5508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10017955 | LOVELACE (01) | NM |
102935 | (05) | AZ |
H40216 | (02) | |
NM001H34 | BCBS (01) | NM |
PROVP15878 | MOLINA (01) | NM |
S0884 | (05) | NM |