Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD183678 | OR |
N | 208600000X | Surgeon | MD183678 | OR |
N | 208200000X | Surgeon | MD2018-0599 | NM |
N | 208600000X | Surgeon | MD2018-0599 | NM |
Y | 2086S0102X | Surgical Critical Care | MD2018-0599 | NM |
N | 2086S0127X | Trauma Surgeon | MD2018-0599 | NM |
NPI | 1255697033 |
---|---|
Provider Name | Richard J Miskimins |
First Address | Albuquerque, NM 87106-4375 |
Second Address | Albuquerque, NM 87106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2012 |
Last Update Date | 06/08/2018 |