Healthcare Provider Details

I. General information

NPI: 1538324488
Provider Name (Legal Business Name): HIGH DESERT DOPPLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 LA PLAYA ST NE
ALBUQUERQUE NM
87111-3409
US

IV. Provider business mailing address

9501 LA PLAYA ST NE
ALBUQUERQUE NM
87111-3409
US

V. Phone/Fax

Practice location:
  • Phone: 505-350-3397
  • Fax:
Mailing address:
  • Phone: 505-350-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN KENNETH AYER JAIN JR.
Title or Position: PRESIDENT
Credential: RVT
Phone: 505-350-3397