Healthcare Provider Details

I. General information

NPI: 1588387591
Provider Name (Legal Business Name): MR. VERNON LEE DRUMMOND JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BASILLIO DRIVE
GALLUP NM
87301
US

IV. Provider business mailing address

PO BOX 1318 600 SOUTH BOARDMAN
GALLUP NM
87305-1318
US

V. Phone/Fax

Practice location:
  • Phone: 505-721-1800
  • Fax: 505-721-1899
Mailing address:
  • Phone: 505-721-1000
  • Fax: 505-721-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number55435
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: