Healthcare Provider Details

I. General information

NPI: 1184709222
Provider Name (Legal Business Name): AUBREY EARL RAGLAND D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 MONTGOMERY BLVD NE SUITE 206
ALBUQUERQUE NM
87109-1500
US

IV. Provider business mailing address

3301 MONROE ST NE #J101
ALBUQUERQUE NM
87110-1860
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-1701
  • Fax: 505-884-1785
Mailing address:
  • Phone: 505-884-1485
  • Fax: 505-888-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number687
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: