Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 99-116 | NM |
Y | 208600000X | Surgeon | 99-116 | NM |
NPI | 1003894130 |
---|---|
Provider Name | Charles J.s. Guimaraes |
First Address | Gallup, NM 87301-5683 |
Second Address | Gallup, NM 87301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10002629 | LOVELACE HEALTH/SALUD (01) | NM |
465668 | (05) | AZ |
84984872 | (05) | NM |
85031326887301A023 | CHAMPUS (01) | |
G91527 | (02) | |
NM004683 | BC/BS (01) | NM |
PROVP12644 | MOLINA (01) | NM |