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NPI Code Detail

MEDICARE: TIMOTHY J GRENEMYER DO

MEDICARE: TIMOTHY J GRENEMYER DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianA96392NM

General Provider Information

NPI Number : 1588699391
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY J GRENEMYER DO
Provider Business Mailing Address
First Line : PO BOX 27829
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87125
Country : US
Telephone Number : 505-232-1920
Fax Number : 505-727-9276
Provider Business Practice Location Address
First Line : 1901 JUAN TABO BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87112-3303
Country : US
Telephone Number : 505-407-2163
Fax Number : 505-407-2125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 04/24/2024

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