Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 76-228 | NM |
NPI | 1033194378 |
---|---|
Provider Name | Dr. David M Macias |
First Address | Santa Fe, NM 87505-3357 |
Second Address | Santa Fe, NM 87505-3357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 17/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D35798 | (02) | NM |
Y0721 | (05) | NM |