MEDICARE: RONALD BLISS 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	207Q00000X	Family Medicine Physician	2000-145	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NM004266	OTHER	NM	BLUE CROSS
3	80156045	OTHER		RAILROAD RETIREMENT
4	20592	OTHER	NM	LOVELACE
5	57647	OTHER	NJ	PRESBYTERIAN SALUD

General Provider Information

NPI Number	:	1912985946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD BLISS MD

Provider Business Mailing Address
First Line	:	2300 E 30TH ST
Second Line	:	BLDG B, STE 102
City	:	FARMINGTON
State	:	NM
Zip	:	87401-8990
Country	:	US
Telephone Number	:	505-324-1000
Fax Number	:	505-324-1199

Provider Business Practice Location Address
First Line	:	2300 E 30TH ST
Second Line	:	BLDG B, STE 102
City	:	FARMINGTON
State	:	NM
Zip	:	87401-8990
Country	:	US
Telephone Number	:	505-324-1000
Fax Number	:	505-324-1199

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	01/22/2008

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Directions to “ RONALD BLISS MD” Practice Location

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