Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 1397 | NM |
NPI | 1063470904 |
---|---|
Provider Name | Dr. James D Crine II |
First Address | Albuquerque, NM 87111 |
Second Address | Albuquerque, NM 87111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5771071 | AETNA (01) | |
619420 | UNITED CONCORDIA (01) | |
8600 | BLUE CROSS BLUE SHIELD (01) | |
86025 | (05) | NM |
T40793 | (02) |