Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | DR.0056347 | CO |
N | 207Q00000X | Family Doctor | H4646 | TX |
Y | 207Q00000X | Family Doctor | MD2010-0703 | NM |
NPI | 1003861618 |
---|---|
Provider Name | Gayle E Riley |
First Address | Farmington, NM 87499-6210 |
Second Address | Aztec, NM 87410-2172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 20/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E51600 | (02) |