Healthcare Provider Details

I. General information

NPI: 1427254572
Provider Name (Legal Business Name): JEREMY CLERVEN PARSONS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE DEPARTMENT OF PATHOLOGY
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

1100 CENTRAL AVE SE DEPARTMENT OF PATHOLOGY
ALBUQUERQUE NM
87106-4930
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1330
  • Fax: 505-841-1373
Mailing address:
  • Phone: 505-841-1331
  • Fax: 505-841-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberMD2013-0793
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: