Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 98-13 | NM |
NPI | 1063410116 |
---|---|
Provider Name | Mark Bieri |
First Address | Las Cruces, NM 88011-9107 |
Second Address | Las Cruces, NM 88011-9107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 02/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
94071861 | (05) | NM |
G67637 | (02) | |
NM004961 | BLUE CROSS BLUE SHIELD (01) | NM |