Healthcare Provider Details

I. General information

NPI: 1366497422
Provider Name (Legal Business Name): NANCY JEAN STARR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 MEDICAL DR STE A
ALAMOGORDO NM
88310
US

IV. Provider business mailing address

2559 MEDICAL DR STE A
ALAMOGORDO NM
88310
US

V. Phone/Fax

Practice location:
  • Phone: 505-434-1500
  • Fax: 505-434-1680
Mailing address:
  • Phone: 505-434-1500
  • Fax: 505-434-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number75254
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: