Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A-761-83 | NM |
NPI | 1821060534 |
---|---|
Provider Name | Eric James Freeh |
First Address | Alamogordo, NM 88310-4607 |
Second Address | Alamogordo, NM 88310-4607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 17/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000L1222 | (05) | NM |
201003233 | PRESBYTERIAN (01) | NM |
E44488 | (02) | NM |
NM014064 | BLUE CROSS BLUE SHIELD (01) | NM |