Healthcare Provider Details

I. General information

NPI: 1831307594
Provider Name (Legal Business Name): PARLEY D FILLMORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 10TH ST
ALAMOGORDO NM
88310-6414
US

IV. Provider business mailing address

1124 10TH ST
ALAMOGORDO NM
88310-6414
US

V. Phone/Fax

Practice location:
  • Phone: 575-434-1200
  • Fax: 575-437-3947
Mailing address:
  • Phone: 575-434-1200
  • Fax: 575-437-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberR-7727
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD2009-0470
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: