Healthcare Provider Details

I. General information

NPI: 1932123288
Provider Name (Legal Business Name): FARMINGTON INTERNAL MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657A W MAPLE ST
FARMINGTON NM
87401-5967
US

IV. Provider business mailing address

657A W MAPLE ST
FARMINGTON NM
87401-5967
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-5025
  • Fax: 505-325-0689
Mailing address:
  • Phone: 505-325-5025
  • Fax: 505-325-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ELEANORE BARRY-PRATHER
Title or Position: OWNER
Credential: MD
Phone: 505-325-5025