Healthcare Provider Details

I. General information

NPI: 1245519115
Provider Name (Legal Business Name): RANEY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 W PIERCE ST SUITE 3 C
CARLSBAD NM
88220-3537
US

IV. Provider business mailing address

2402 W PIERCE ST SUITE 3 C
CARLSBAD NM
88220-3537
US

V. Phone/Fax

Practice location:
  • Phone: 575-887-0530
  • Fax: 575-885-6309
Mailing address:
  • Phone: 575-887-0530
  • Fax: 575-885-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1747
License Number StateNM

VIII. Authorized Official

Name: DR. JEREMIAH KENT RANEY
Title or Position: PRES
Credential: MD
Phone: 575-887-0530