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1649231150

NPI Code Detail

MEDICARE: PETER M SELZER MD

MEDICARE: PETER M SELZER MD

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
1	2085R0204X	Vascular & Interventional Radiology Physician	94-391	NM
2	2085R0202X	Diagnostic Radiology Physician	94-391	NM

General Provider Information

NPI Number	:	1649231150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER M SELZER MD

Provider Business Mailing Address
First Line	:	1397 WEIMER RD
Second Line	:
City	:	TAOS
State	:	NM
Zip	:	87571-6253
Country	:	US
Telephone Number	:	575-751-5872
Fax Number	:	575-751-5869

Provider Business Practice Location Address
First Line	:	1397 WEIMER RD
Second Line	:
City	:	TAOS
State	:	NM
Zip	:	87571-6253
Country	:	US
Telephone Number	:	575-751-5871
Fax Number	:	575-751-5860

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	11/07/2019

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Directions to “ PETER M SELZER MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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