Healthcare Provider Details

I. General information

NPI: 1558658591
Provider Name (Legal Business Name): THOMAS E EARNEST JR. D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4808 MESA PRIETA CT NW
ALBUQUERQUE NM
87120-4620
US

IV. Provider business mailing address

4808 MESA PRIETA CT NW
ALBUQUERQUE NM
87120-4620
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-2949
  • Fax:
Mailing address:
  • Phone: 505-899-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number932
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: