Healthcare Provider Details

I. General information

NPI: 1265527642
Provider Name (Legal Business Name): R STEPHEN RANKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E 30TH ST BLDG C2
FARMINGTON NM
87401-8990
US

IV. Provider business mailing address

2300 E 30TH ST BLDG C2
FARMINGTON NM
87401-8990
US

V. Phone/Fax

Practice location:
  • Phone: 505-324-1000
  • Fax: 505-324-1199
Mailing address:
  • Phone: 505-324-1000
  • Fax: 505-324-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-370
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: