Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A-1091-98 | NM |
NPI | 1003852252 |
---|---|
Provider Name | Patrick J Homer |
First Address | Lovington, NM 88260-2830 |
Second Address | Lovington, NM 88260-2813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 09/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G71450 | (02) | |
S8178 | (05) | NM |