Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD2014-0755 | NM |
N | 207Q00000X | Family Doctor | RS2012-0466 | NM |
N | 207QS0010X | Family Doctor - Sports Medicine | 32151 | OK |
NPI | 1003178013 |
---|---|
Provider Name | Eric Sandoval |
First Address | Las Cruces, NM 88011-5069 |
Second Address | Tulsa, OK 74120-5440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2012 |
Last Update Date | 24/05/2016 |