Basic Information
| Provider Information | |||||||||
| NPI: | 1144275959 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RACE | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2669 SCENIC DR | ||||||||
| Address2: | |||||||||
| City: | ALAMOGORDO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 883108700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159556767 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2539 MEDICAL DR | ||||||||
| Address2: | STE 110 | ||||||||
| City: | ALAMOGORDO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 883108720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754342116 | ||||||||
| FaxNumber: | 5754342051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD2009-0724 | NM | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 35351 | 01 | IA | WELLMARK | OTHER | 36167 | 01 | IA | WELLMARK | OTHER | F244880 | 01 | IA | MIDLANDS | OTHER | 1175 | 01 | IA | MIDLANDS | OTHER | DC9737 | 01 | IA | RR MEDICARE | OTHER | 9098947 | 05 | IA | MEDICAID | P00041350 | 01 | IA | RR MEDICARE | OTHER | 0425561 | 05 | IA | MEDICAID |