Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD2004-0317 | NM |
NPI | 1023060696 |
---|---|
Provider Name | Dr. Nicholas M. Mittica JR. |
First Address | Silver City, NM 88061-4847 |
Second Address | Silver City, NM 88061-4847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 11/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
27502562 | (05) | NM |
H27044 | (02) | NM |