Healthcare Provider Details

I. General information

NPI: 1366652893
Provider Name (Legal Business Name): GEORGE DOUGLAS LOYD R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E 30TH ST
FARMINGTON NM
87401
US

IV. Provider business mailing address

4200 HOLIDAY DR
FARMINGTON NM
87402-4638
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-0333
  • Fax: 505-327-0159
Mailing address:
  • Phone: 505-327-4215
  • Fax: 505-327-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR29485
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: