Healthcare Provider Details

I. General information

NPI: 1639285208
Provider Name (Legal Business Name): JEREMIAH KENT RANEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

2402 W PIERCE ST STE 3C
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 Number82-111
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: