Basic Information
| Provider Information | |||||||||
| NPI: | 1518088392 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNAL MEDICINE DOCTORS OF LAS CRUCES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1560 | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880041560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5056478366 | ||||||||
| FaxNumber: | 5056478381 | ||||||||
| Practice Location | |||||||||
| Address1: | 1605 EL PASEO RD | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880016013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055272600 | ||||||||
| FaxNumber: | 5055275342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 01/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | NATTAKOM | ||||||||
| AuthorizedOfficialFirstName: | SHINEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5055272600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.