Healthcare Provider Details

I. General information

NPI: 1710175872
Provider Name (Legal Business Name): J GAREY RITCHIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2007
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 E 20TH ST STE C
FARMINGTON NM
87401-4281
US

IV. Provider business mailing address

904 E 20TH ST STE C
FARMINGTON NM
87401-4281
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-0444
  • Fax: 505-327-0446
Mailing address:
  • Phone: 505-327-0444
  • Fax: 505-327-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number144
License Number StateNM

VIII. Authorized Official

Name: MARIE RITCHIE
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-327-0444