Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD2007-0794 | NM |
NPI | 1013092899 |
---|---|
Provider Name | Ramona V. Anderson |
First Address | Gallup, NM 87305-1337 |
Second Address | Gallup, NM 87301-1337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 26/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60371838 | (05) | NM |