Mark Edward Van Wormer
General Practice Physician
314 N 3rd Ave
Clayton
, New Mexico 88415-3302
Mark Edward Van Wormer
General Practice Physician
314 N 3rd Ave
Clayton
, New Mexico 88415-3302
(575) 374-2064
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About
Features
Specialties
- General Practice Physician
Languages spoken
- English
Location
First Address
- Mark Edward Van Wormer
- 314 N 3rd Ave
- Clayton, NM
- Zip : 88415-3302
- Fax : (575) 374-2064
- Phone : (575) 374-8313
Second Address
- Mark Edward Van Wormer
- 314 N 3rd Ave
- Clayton, NM
- Zip : 88415-3302
- Fax : (575) 374-2064
- Phone : (575) 374-8313
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208D00000X | General Practice Physician | 81333 | NM |
National Provider Identifier
| NPI | 1013919034 |
|---|---|
| Provider Name | Mark Edward Van Wormer |
| First Address | Clayton, NM 88415-3302 |
| Second Address | Clayton, NM 88415-3302 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/08/2005 |
| Last Update Date | 15/07/2009 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 05645 | (05) | NM |
| 060000475 | RAILROAD MEDICARE (01) | |
| D43339 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.