Healthcare Provider Details

I. General information

NPI: 1366639882
Provider Name (Legal Business Name): JAIME SOLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 COLUMBUS RD
DEMING NM
88030-5251
US

IV. Provider business mailing address

1413 COLUMBUS RD
DEMING NM
88030-5251
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-6548
  • Fax:
Mailing address:
  • Phone: 575-546-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD2008-0592
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: