Healthcare Provider Details

I. General information

NPI: 1437193232
Provider Name (Legal Business Name): ALAN F ALARCON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W. MAPLE
FARMINGTON NM
87401
US

IV. Provider business mailing address

802 W. APACHE
FARMINGTON NM
87401
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-1572
  • Fax:
Mailing address:
  • Phone: 505-325-1572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2006-0161
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: